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Nurses are missing from influential roles at a swathe of new primary care networks (PCNs), designed to connect GP practices and boost integrated care in England, a year after they were set up, Nursing Times has been told.
The clinical director of one of the new PCNs, in Somerset, warned that one of the constraints of the initiative was that nurses were not included in the umbrella of funded positions within the networks.
In addition, the lack of nurses in clinical director roles meant there was “a long way to go” before nursing stood at the forefront of the initiative, she said.
“It would be utterly amazing if we could use the PCN funding for nursing reimbursable roles”
A year after the new networks were launched, Nursing Times spoke to Kat Dalby-Welsh (pictured) clinical director of Yeovil PCN, who is also a nurse by background.
Ms Dalby-Welsh said that nursing had been missed within recent PCN work and that more needed to be done to raise the profile of nurses in the networks.
As part of the new general practice contract, launched in July 2019, surgeries in England are required to develop partnerships with neighbouring practices to serve a population of between 30,000 to 50,000.
These networks also involve other key health and social care organisations in the same geographical area in order to provide more integrated services to their communities.
Reflecting on the past year, Ms Dalby-Welsh said the main benefits of the new PCNs was that practices had “started talking to each other” and had begun “working collaboratively”.
But she flagged that one of the constraints of the system was that it was “quite rigid” and that nurses were being “missed out” due to part of the funding mechanism for roles within the networks.
Under the Additional Role Reimbursement Scheme, NHS England funds specific roles, including occupational therapists, clinical pharmacists and care co-ordinators to be employed by the PCN, but nurses are not included.
“It would be utterly amazing if we could use the PCN funding for nursing reimbursable roles,” said Ms Dalby-Welsh, who is also associate director of community transformation at Yeovil District Hospital.
“We’ve got a long way to go with primary care nurses being at the forefront”
“At the moment, it is strict around who we can and can’t employ with reimbursable funding. I think that nurses have been missed out of that. They are not currently a reimbursable role,” she told Nursing Times.
She flagged that mental health nurses in particular would be an “amazing” addition to the team.
Allowing PCNs to “make their own decisions around how they want to develop their network, without having to go through middle-men would be great”, added Ms Dalby-Welsh.
“With somewhere like Yeovil, in which we have a really strong vision of where we want to go, it would be great if somebody just said ‘yes, we trust you, we trust you with the care of the people that live in Yeovil, so actually we trust you with how you’re going to spend the money’,” she said.
Her thoughts on the flexibility of roles and funding them were echoed by a report published today by the NHS Confederation, which reviewed the past 12 months of PCNs.
It said there was an “opportunity to give clinical directors more autonomy over the roles they need within their workforce to best meet the needs of their population and that means a more flexible Additional Role Reimbursement Scheme”.
“Clinical directors and their teams need to be given the freedom to fully use and maximise their competences in order to provide clinical leadership at neighbourhood and place levels,” the report added.
On the whole, Ms Dalby-Welsh said that “what has been missing from the PCN work has been nursing”. For example, she highlighted that less than 20 of 1,200 clinical directors were nurses.‘
“What has been missing from the PCN work has been nursing”
This was an issue that had previously been raised to Nursing Times by the Queen’s Nursing Institute back in May last year.
The QNI had called on the NHS to take action to elevate more nurses into leadership roles in primary care.
Ms Dalby-Welsh said: “There are 19 clinical directors who are nurses, it might be down to 18 now, out of 1,200 – I mean it’s a drop in the ocean isn’t it. So, we’ve got a long way to go with primary care nurses being at the forefront.”
Some clinical commissioning groups (CCG) around the country had funded PCN lead nurse roles, noted Ms Dalby-Welsh, who added that this would be a great move to roll out.
One positive for nurses in PCNs was that initiatives, such as nurse-led group consultations, had been “increasing hugely”.
“Nurses are problem solvers and quite often will give a very logical solution to the ongoing challenges of the patients that they are actually caring for,” added Ms Dalby-Welsh.
“They know these patients and supporting this to develop and realise these ideas that they have, using [quality improvement] and using things like group consultations, is the way that nurses will start to raise their profile and once they do that I hope that they will build in confidence to take on the bigger roles.”
In her role as clinical director at the PCN over the past year, Ms Dalby-Welsh said it had been an “extraordinary journey”.
She described PCNs as a “great leveller”, noting that this reason was “why nurses should be confident to take part because it is a level playing field”.
Nursing Times has contacted NHS England for a response.