Expanding the role of community nurses in population health management: a call to action
Two community nurse fellows under the Chief Nursing Officer, England, have been tasked with expanding the role of community nurses in population health management, focusing on two outcomes:
- To establish community nurses' leadership role in articulating local population vulnerabilities and health needs
- To ensure health inequalities are prioritised on the input from Community Nursing
This is building onto the engagement work started by Hilary Garratt's Office in 2021, to develop the first ever National Community Nursing Plan (NCNP). The vision of the NCNP is to build and support the Community Nursing Workforce, so that everyone in England has the high-quality care they need, in a place they choose.
Why is population health management important?
Expanding the role of community nurses in population health management was identified as a need by community nurses during initial consultations. Furthermore, population health management is strongly recommended in The NHS Long Term Plan (2019) and the Green Paper on Prevention (Department of Health and Social Care (DHSC), 2020) as the preferred approach for addressing the prevention of preventable illnesses. This is achieved by tackling the causes of ill health and social determinants of health, which are responsible for perpetuating health inequalities.
We have a heightened need to embrace population health management, considering data insights from the first wave of the pandemic have confirmed the role that health inequalities played in health outcomes of many who succumbed to Covid-19 (Race Disparity Unit, 2021). Disconcerting too, is evidence that, health inequalities are linked to the apparent setback to life expectancy gains that were already being experienced by some regions in England, even before the pandemic (Rashid et al, 2021).
How will population health management be delivered?
Integrated Care Boards (ICBs) through Primary Care Networks, are heralded as the biggest enablers of population health management by facilitating effective collaborative working between different stakeholders, to tackle the social determinants of health (DHSC, 2021). If applied through the lens of the Core20PLUS5 framework (National Health Service (NHS), 2021), underpinned by digital capabilities, population health management can facilitate provision of information on populations with the greatest needs, helping ICBs align services and resources to tackle current, and predict future needs (Duncan, 2019).
The role of community nurses in population health management
Population health management is not new to nurses; since the time of Florence Nightingale, nurses have undertaken a holistic approach to care, taking into consideration the role played by non-clinical factors on health outcomes (Ariosto, 2018). Patients tend to trust nurses, and community nurses have privileged access to patients in their homes, communities and at critical life events. This makes them well placed to deliver population health management activities to support people along their life course, through the promotion of health and wellness, disease prevention and management of long-term conditions (National Advisory Council on Nurse Education and Practice (NACNEP), 2016). Yet despite this, community nurses have not always relished in the prominence enjoyed by their counterparts in acute hospital settings.
However, community nurses' adaptability to new ways of working at the peak of the pandemic, using digital technology to help prevent hospital admissions through safe management of patients in their homes, is not unnoticed (Green, 2020). Future plans to deliver more services in the community demand an acknowledgement of the strategic role that community nurses play as key stakeholders in ICBs, essential for the successful delivery of Long-Term Plan ambitions on new models of care (NHS, 2019). Hence Matthew Winn (2020), the NHSEI Director of Community Services' rightful description of Community Nurses as:
‘The backbone of community services in health and care in England. If we can utilise the skills and experience of every single community nurse, we have laid the foundations of a world class health and care integration.”
What have we been doing?
We have been actively engaged in learning about the different contexts that community nurses are currently working in. We are committed to co-producing with community nurses' strategies and have successfully engaged with community nurses through staff meetings, webinars, social media platforms and through an online survey to reflect their voices.
Insights from our engagement sessions have enabled us to draw out 4 themes and problem statements presented in the diagram below. These insights will enable our collaboration to start to determine the nature and format in which to deliver the support needed by community nurses to develop the knowledge, skills, confidence and attitudes to step into their leadership role in population health management in ICBs.
Our call for action
We have a remarkable opportunity to build on this momentum as we define, establish, and expand the role of community nurses in population health management whilst demonstrating and cementing their value within ICBs.
If you would like to comment on this article or contribute, please contact us using this email address: england.communitynursing@nhs.net