Art & science | NHS reform
New responsibilities in purchasing and developing services Nurses working in clinical commissioning groups are seeking ways to improve care. To achieve this they will need colleagues to get involved too, say Soline Jerram and Ann Fox Correspondence [email protected]
Abstract
Soline Jerram is director of clinical quality and primary care, Brighton and Hove Clinical Commissioning Group, Brighton Ann Fox is director of nursing quality and safety, NHS Sunderland and South Tyneside Clinical Commissioning Group, Sunderland Date of submission March 10 2014 Date of acceptance April 22 2014 Peer review This article has been subject to double-blind review and has been checked using antiplagiarism software Author guidelines nop.rcnpublishing.com
The role of nursing in the NHS commissioning structure in England is developing. Since April 2013 more than 200 clinical commissioning groups (CCGs), which comprise all GP practices in the locality, have taken on responsibility for health budgets in their areas. This article describes the challenges ahead and nurses’ responsibilities in CCGs when working with local citizens and across the health and social care system to assure the delivery of high quality, safe services. Keywords Clinical commissioning groups, commissioning, community health services, England, health budgets, healthcare services, NHS ON APRIL 1 2013 the commissioning (buying) and monitoring of most of the health care delivered by hospitals and community health services across England changed with the introduction of clinical commissioning groups (CCGs). CCGs are delegated this responsibility by NHS England, formerly the NHS Commissioning Board. As well as monitoring the performance of CCGs, NHS England has commissioning responsibilities of its own which include general practice, dentists, pharmacies and some specialist health services. CCGs, as the name suggests, consist of doctors, nurses and other health professionals, with support from experienced health service managers. They represent commissioning that is clinically led and managerially enabled. A further difference in CCGs compared with their predecessor organisations, primary care trusts, is that all of the GP practices in the locality covered by the individual CCGs, 211 in total, have to be a member of their local CCG organisation.
24 June 2014 | Volume 26 | Number 5
One of the reasons for this change was to enable the purchase and development of health and social care services to be informed by clinicians who interact with patients and their families on a daily basis, refer to and work with front line staff in their local hospitals, community and mental health organisations. GPs provide a list-based service, which means they are responsible for the health care of the people on their list. In England, with some exceptions, every member of the population is registered with a GP. GPs and their practice teams are obliged to improve the quality of primary care services and ensure that their knowledge and experience inform the development of local health and social care systems. This process is informed and influenced by engaging patients and their families in conversations about how they wish to receive services. These changes, along with the learning from the major reports by Berwick, Francis and Keogh (Department of Health (DH) 2013 a-c), require each professional to develop, monitor, assure and feedback information to ensure cost-effective, quality, safe services are being delivered in their community. Front line staff, wherever they work, can no longer see the quality and safety of health and social care services as ‘someone else’s’ job. It is everyone’s job.
Governing bodies Great emphasis has been placed on getting GPs to be a full part of the system. CCGs are required to have a lay registered nurse on the governing body, many of these nurses work two days a month. However, in a number of CCGs the knowledge and experience of nurses is recognised, and many CCGs have chief nurses/directors of nursing and quality in executive positions, although not all. NURSING OLDER PEOPLE
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 27, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
iStock
The nurse in a CCG has a range of responsibilities but without fail they include quality and patient safety. They are there to assess, review and monitor care delivered in the whole community, in hospitals, in homes and in care homes. They are responsible for assuring that services are commissioned and delivered to improve patient experience and that health and social care providers work collaboratively. Delivery of a high quality, safe and effective health and social care system that meets the challenges of an ageing population, increasing numbers of people with dementia, and a greater number of people with long-term conditions delivered with reduced resources is not one for just nurses to tackle. However, we would not be abiding by our professional code or our responsibilities under the NHS Constitution (DH 2013d) if we did not accept that nurses have a significant role in ensuring the positive improvements that are required and the different ways of working that need to be implemented. Nurses, midwives and health visitors work in all parts of the community, supporting individuals and their families at times of distress, illness, vulnerability and joy. No other profession is afforded the trust of strangers to be part of their lives in so many intimate circumstances. However, the role also holds huge responsibilities that have not been fully understood or honoured by some nurses in recent years. Nurses should not underestimate the contribution they can make to the survival and further development of the NHS at a time when workloads are increasing and finances are diminishing. Nursing care delivered well, planned by nurses, monitored by nurses, can change lives. NURSING OLDER PEOPLE
Nurses working in partnership with patients’ carers and other professional health and social care partners and the larger community make a difference, in the moment and over a lifetime. The care and communication that midwives and health visitors show at the birth of a child will affect generations to follow. Nurses who support families through the loss of loved ones will affect their wellbeing at that time and in the future. If done well the information nurses give people about their newly diagnosed condition can empower them to self-care, and if not can make them scared and dependent. So why would we not want to ensure we have a large amount to contribute about how services are commissioned, delivered and managed? Who better to use their knowledge and experience to say what good care looks like? What other professional gathers stories about patients’ and carers’ experience? Putting patients and their families first, and engaging while actively listening and acting with them is paramount.
Get involved CCGs’ remit is to work with citizens to plan and develop health and social care services for their communities, with their communities. CCGs need to commission services to ensure care is delivered seamlessly with acute, community, mental health, care homes and primary care working in partnership. CCG nurses are at the centre of this mandate, but so are you. Get involved. Ensure you know your CCG, the nurse on the governing body and the head of quality and patient safety. They will be visiting your organisation, working closely with your local authority, and be part of developing in and out of hospital pathways of care. They will want to hear from nurses working in the area they are responsible for. It is no longer a case of ‘the commissioner’ and ‘the management’; it is ‘we’ and ‘us’. We all need to make this work and make it better for patients and carers. Nursing may have borne the brunt of criticism for the poor delivery of health care over the past few years, but the profession has also been responsible for continuing to develop and deliver care. Now it has a responsibility to make it better. References Department of Health (2013a) A Promise to Learn – A Commitment to Act. tinyurl.com/k9peqrf (Last accessed: May 6 2014.) Department of Health (2013b) Mid Staffordshire NHS Foundation Trust Public Inquiry: Government Response. http://francisresponse.dh.gov.uk (Last accessed: May 6 2014.) Department of Health (2013c) Review into the Quality of Care and Treatment Provided by 14 Hospital Trusts in England: Overview Report. tinyurl.com/ph9e267 (Last accessed: May 6 2014.) Department of Health (2013d) The NHS Constitution – The NHS Belongs to Us All. tinyurl.com/d2zubyk (Last accessed: May 6 2014.)
Online archive For related information, visit our online archive and search using the keywords Conflict of interest None declared
June 2014 | Volume 26 | Number 5 25
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 27, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
New responsibilities in purchasing and developing services Nurses working in clinical commissioning groups are seeking ways to improve care. To achieve this they will need colleagues to get involved too, say Soline Jerram and Ann Fox Correspondence [email protected]
Abstract
Soline Jerram is director of clinical quality and primary care, Brighton and Hove Clinical Commissioning Group, Brighton Ann Fox is director of nursing quality and safety, NHS Sunderland and South Tyneside Clinical Commissioning Group, Sunderland Date of submission March 10 2014 Date of acceptance April 22 2014 Peer review This article has been subject to double-blind review and has been checked using antiplagiarism software Author guidelines nop.rcnpublishing.com
The role of nursing in the NHS commissioning structure in England is developing. Since April 2013 more than 200 clinical commissioning groups (CCGs), which comprise all GP practices in the locality, have taken on responsibility for health budgets in their areas. This article describes the challenges ahead and nurses’ responsibilities in CCGs when working with local citizens and across the health and social care system to assure the delivery of high quality, safe services. Keywords Clinical commissioning groups, commissioning, community health services, England, health budgets, healthcare services, NHS ON APRIL 1 2013 the commissioning (buying) and monitoring of most of the health care delivered by hospitals and community health services across England changed with the introduction of clinical commissioning groups (CCGs). CCGs are delegated this responsibility by NHS England, formerly the NHS Commissioning Board. As well as monitoring the performance of CCGs, NHS England has commissioning responsibilities of its own which include general practice, dentists, pharmacies and some specialist health services. CCGs, as the name suggests, consist of doctors, nurses and other health professionals, with support from experienced health service managers. They represent commissioning that is clinically led and managerially enabled. A further difference in CCGs compared with their predecessor organisations, primary care trusts, is that all of the GP practices in the locality covered by the individual CCGs, 211 in total, have to be a member of their local CCG organisation.
24 June 2014 | Volume 26 | Number 5
One of the reasons for this change was to enable the purchase and development of health and social care services to be informed by clinicians who interact with patients and their families on a daily basis, refer to and work with front line staff in their local hospitals, community and mental health organisations. GPs provide a list-based service, which means they are responsible for the health care of the people on their list. In England, with some exceptions, every member of the population is registered with a GP. GPs and their practice teams are obliged to improve the quality of primary care services and ensure that their knowledge and experience inform the development of local health and social care systems. This process is informed and influenced by engaging patients and their families in conversations about how they wish to receive services. These changes, along with the learning from the major reports by Berwick, Francis and Keogh (Department of Health (DH) 2013 a-c), require each professional to develop, monitor, assure and feedback information to ensure cost-effective, quality, safe services are being delivered in their community. Front line staff, wherever they work, can no longer see the quality and safety of health and social care services as ‘someone else’s’ job. It is everyone’s job.
Governing bodies Great emphasis has been placed on getting GPs to be a full part of the system. CCGs are required to have a lay registered nurse on the governing body, many of these nurses work two days a month. However, in a number of CCGs the knowledge and experience of nurses is recognised, and many CCGs have chief nurses/directors of nursing and quality in executive positions, although not all. NURSING OLDER PEOPLE
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 27, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
iStock
The nurse in a CCG has a range of responsibilities but without fail they include quality and patient safety. They are there to assess, review and monitor care delivered in the whole community, in hospitals, in homes and in care homes. They are responsible for assuring that services are commissioned and delivered to improve patient experience and that health and social care providers work collaboratively. Delivery of a high quality, safe and effective health and social care system that meets the challenges of an ageing population, increasing numbers of people with dementia, and a greater number of people with long-term conditions delivered with reduced resources is not one for just nurses to tackle. However, we would not be abiding by our professional code or our responsibilities under the NHS Constitution (DH 2013d) if we did not accept that nurses have a significant role in ensuring the positive improvements that are required and the different ways of working that need to be implemented. Nurses, midwives and health visitors work in all parts of the community, supporting individuals and their families at times of distress, illness, vulnerability and joy. No other profession is afforded the trust of strangers to be part of their lives in so many intimate circumstances. However, the role also holds huge responsibilities that have not been fully understood or honoured by some nurses in recent years. Nurses should not underestimate the contribution they can make to the survival and further development of the NHS at a time when workloads are increasing and finances are diminishing. Nursing care delivered well, planned by nurses, monitored by nurses, can change lives. NURSING OLDER PEOPLE
Nurses working in partnership with patients’ carers and other professional health and social care partners and the larger community make a difference, in the moment and over a lifetime. The care and communication that midwives and health visitors show at the birth of a child will affect generations to follow. Nurses who support families through the loss of loved ones will affect their wellbeing at that time and in the future. If done well the information nurses give people about their newly diagnosed condition can empower them to self-care, and if not can make them scared and dependent. So why would we not want to ensure we have a large amount to contribute about how services are commissioned, delivered and managed? Who better to use their knowledge and experience to say what good care looks like? What other professional gathers stories about patients’ and carers’ experience? Putting patients and their families first, and engaging while actively listening and acting with them is paramount.
Get involved CCGs’ remit is to work with citizens to plan and develop health and social care services for their communities, with their communities. CCGs need to commission services to ensure care is delivered seamlessly with acute, community, mental health, care homes and primary care working in partnership. CCG nurses are at the centre of this mandate, but so are you. Get involved. Ensure you know your CCG, the nurse on the governing body and the head of quality and patient safety. They will be visiting your organisation, working closely with your local authority, and be part of developing in and out of hospital pathways of care. They will want to hear from nurses working in the area they are responsible for. It is no longer a case of ‘the commissioner’ and ‘the management’; it is ‘we’ and ‘us’. We all need to make this work and make it better for patients and carers. Nursing may have borne the brunt of criticism for the poor delivery of health care over the past few years, but the profession has also been responsible for continuing to develop and deliver care. Now it has a responsibility to make it better. References Department of Health (2013a) A Promise to Learn – A Commitment to Act. tinyurl.com/k9peqrf (Last accessed: May 6 2014.) Department of Health (2013b) Mid Staffordshire NHS Foundation Trust Public Inquiry: Government Response. http://francisresponse.dh.gov.uk (Last accessed: May 6 2014.) Department of Health (2013c) Review into the Quality of Care and Treatment Provided by 14 Hospital Trusts in England: Overview Report. tinyurl.com/ph9e267 (Last accessed: May 6 2014.) Department of Health (2013d) The NHS Constitution – The NHS Belongs to Us All. tinyurl.com/d2zubyk (Last accessed: May 6 2014.)
Online archive For related information, visit our online archive and search using the keywords Conflict of interest None declared
June 2014 | Volume 26 | Number 5 25
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 27, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
