What exactly will a nurse consultant do? Pat Healy reports on plans for a pilot scheme to develop the role

Despite all the hype surrounding the prime minister's announcement about£40,000-a-year 'supernurses', there is still very little idea of exactly what a nurse consultant will do.

And while ministers want the first 200-300 to be in post by next April, the nursing profession is more cautious, with the Royal College of Nursing setting up a series of pilot schemes with six trusts to develop the role over the next two years.

For Kim Manley, the RCN Institute senior fellow leading the programme, there is a danger in expecting senior nurses to be ready for their new roles so quickly.

'Even experts need help to demonstrate their ability to combine all the roles involved in being a nurse consultant, ' she says.

The pilot programme aims to establish the competences needed to practise as a consultant nurse, to set up a means of identifying them and to pilot a support and development programme for nurses who intend to take on the role.

A facilitator will work with two nurses who match the criteria in each of the six trusts, and there will be links with university nurse education departments to ensure appropriate evaluation and dissemination of results to others working in similar areas.

Dickon Weir-Hughes, chief nurse and director of patient services at London's specialist cancer hospital, the Royal Marsden, is 'desperately keen' to be involved in the pilots.

The hospital, he points out, has a 20year history of developing advanced nursing practice and was one of the first to develop clinical nurse specialist roles. It has been running a project for the last year to 'set the scene' for nurse consultant roles.

That work, and the Marsden's 'very close relationship' with its education provider, the centre for cancer and palliative care studies, part of the Institute for Cancer Research, makes the hospital 'a good place to pilot this kind of work'.

Mr Weir-Hughes thinks the Marsden is also a good test-bed because its medical consultants are very 'pronursing' and positive about multidisciplinary working.

And he dismisses the notion that the comparatively high cost of nurse consultants will encourage trusts to consider taking on new, cheaper medical consultants instead.

'That idea demonstrates a misunderstanding of the role of nurse consultants, ' he says.

'There are aspects of care and work that are clearly better undertaken by the experienced nurse rather than a medic, just as there are things that medics do better. One of the problems is that in many places nurses are being used in so-called advanced practice roles, but actually what they are doing is taking the workload off doctors and that isn't what this is about.'

The key for Mr Weir-Hughes is meeting patients' needs better - one of the criteria that will be spelled out soon in the promised health service circular on how trusts are expected to implement the government's new nursing strategy.

Making a Difference says nurse consultants will have responsibilities in four main areas: expert practice, professional leadership and consultancy, education and development, and practice and service development linked to research and evaluation.

They will spend 'at least half the time' working directly with patients, and it will be for trusts to establish the number and scope of consultants they wish to employ.

Mr Weir-Hughes is looking for people who are 'already expert in their field' but who need a 'bit of polishing, fine tuning' to adapt to their new role.

The Marsden, he says, is fortunate in having a 'massive graduate workforce'.

Nevertheless, he expects that one of the nurses will be an external candidate. And he is confident that there will be people who will be able to work at nurse consultant level by next April.

Nurse consultants are only a small part of the strategy which NHS Confederation chair of human resources Andrew Foster sees as closely linked with the government's two major initiatives on human resources policies - its HR framework and pay ideas.

He welcomes the fact that trusts will be kite marked on their family friendly policies and says they should not resent this extension of performance management.

'It is a sensible way forward, ' he says.

'The contribution that HR makes to the running of the service is very important, but it needs some help from above.'

The move also dovetails with Agenda for Change, which attempted to remove some of the barriers preventing nurses progressing further by changing increments within grades.

Mr Foster says the strategy will be 'hugely beneficial' to them.

Meanwhile, health secretary Frank Dobson claims the overall drive to improve nurse recruitment and retention is beginning to work, with 1,200 nurses returning to work in the NHS in the 23 weeks since the launch of a major recruitment campaign.

At just over 52 a week, that seems to be slow progress, particularly when some of the returners would probably have come back in any case .

And some nurses may be less than enchanted when they read the small print of the nursing strategy. Nurse consultants will be paid on a range starting at£27,000 - less than the current maximum for an I-grade nurse.