Published: 05/12/2002, Volume112 No. 5834 Page 23

Earlier this year, HSJ published an exchange of letters debating the need for a nurse director on primary care trust boards. This culminated in us making a presentation at a national conference in October, run by the Health Services Management Centre, entitled 'Nurses in PCTs - making their presence felt?'

While we both have some healthy disagreement about the role of nursing director, we are both of the view that senior strategic nursing leadership needs to be present in the PCT and influencing the delivery of services. We are agreed in the outcomes, but differ in the ideal model to achieving them. The polarised stance with which the debate began - that of a shared leadership model utilising the skills of different nurses versus the nurse director model - evolved into a recognition that elements of both are important.

There was agreement at the conference that strategic leadership is vital for balanced decision-making within PCTs and that it still remains largely absent in some. Whatever the organisational/management structure, we have to find a way to enable nurses and other clinicians to develop skills to influence the agenda. Trusts choosing not to appoint a nurse director or support a shared leadership model will need to ensure three things:

Appropriate nurses are present when decisions are being made and they have the credibility required to influence and aid the decision making process.

Nurses are supported to develop political skills and their contribution is valued at all levels of the organisation.

Nursing is developed to support the modernisation agenda and not seen as a development outcome in its own right.

To achieve all this requires a senior player or team of senior nurses who have influence and presence at the executive committee, management team and board. Nurses working in the 30 per cent of PCTs who have not yet taken this on board need to get lobbying and the senior managers of those organisations need to wake up and have an awareness of a key resource that remains untapped.

Yvonne Sawbridge Director of nursing Burntwood, Lichfield and Tamworth PCT Helen Parker Director of clinical services Wyre Forest PCT