We are on the brink of significant changes being made in the NHS, associated with the much-awaited Long Term Plan (LTP) (NHS England, 2019). This will include a focus on integrated care systems (ICSs) and the establishment of merged clinical commissioning groups (CCGs), local place- or borough-based boards and primary care networks (PCNs). Each of these new configurations will impact primary and community care nursing. So, are we ready for it? And, more importantly, do politicians and healthcare policy makers recognise the value of the nursing contribution to this system of systems? I fear not.
If the plan is to work, the NHS will need to ensure that its services are deliverable and affordable and that it answers the test to enable care to shift out of hospitals and closer to people's homes. In doing so, the plan is expected to give local health leaders the freedom to shape and develop the services required in each area. Initial local system plans are required by September 2019, with shadow form implementations to follow soon after, and formal establishment in April 2020. However, we need to question where nurse leadership features in every level of the new ICSs.
The implementation framework for this potentially exciting 10-year plan recognises the dangers of focusing power at the centre, and the importance of handing local health and social care the freedom they need to work together effectively. However, significant tensions remain, and not just between health and social care. Everyone welcomes the idea of joined-up care closer to people's homes, tackling inequalities and improving prevention. However, there seems a lack of focus on the leadership of nurses—the very professionals who will significantly deliver on this agenda. As new organisation structures emerge in the NHS, there appears to be a distinct lack of consistency across the service in recognising the important leadership role of nurses. In at least one new London CCG, covering six previous CCG areas, agreement has been reached to appoint a Chief Nurse and Director of Quality. This post will be in addition to the Governing Body Nurse member required by statute on the CCG board. Additionally, in a few of PCNs, we have seen the appointment of Clinical Directors who are nurses, and, in some, there are plans to appoint nurses as Deputy Clinical Directors as a means of succession planning. These identified roles are to be applauded, and it is hoped that they will be replicated elsewhere.
The lack of visibility for nursing at senior levels in merged CCGs, PCNs and borough-based boards is not always the fault of policy makers and healthcare leaders. Nurses in primary and community care must raise the bar considerably and ensure a place at each table. At all levels, nurses' skills can best be used to offer clinical and professional leadership, quality oversight for LTP delivery, ensure safety and safeguarding of patients and support the patient experience agenda. In the quest to reorganise and redesign the NHS, it would be foolhardy to miss out the vital contribution of proven nurse leadership skills. Recent Care Quality Commission reports (Moore, 2019) awarding outstanding status for community trusts have singled out nurse leadership as a vital contribution for excellent performance, quality improvement, staff engagement and improved morale. These proven skills must now be harnessed if we are to expect the outcomes desired in new ICSs.
For too long, nurses have remained hidden in primary and community care. To put this right in the interest of patients, we need to build a pool of nurses with a level of experience that sustainability and transformation partnerships, ICSs and borough-based boards can use in every area, both as expert sounding boards and as visible leaders within the system. There is a real need for us, particularly in primary care nursing, to play ‘catch-up’ in relation to talent management.
The World Health Organization has been identified as the 2020 Year of the Nurse. As a profession, we owe it to our patients to rise to the test of nurse clinical leadership in the transformed NHS.