The Royal College of Nursing’s head of policy and international Howard Catton talks to Ruslan Zinchenko about designing staffing policies based on patient need.

In the attempt to move healthcare away from the acute setting into the community it is important that all of those involved decide on how they want this to happen. Currently there is not enough alignment of workforce planning with service planning for this acute to community transition.

At the moment we see very few comprehensive workforce plans set alongside proposals for new community-based healthcare. In the last decade, the proportion of nursing staff working in the acute care has stayed broadly the same. If we want to radically alter where care is delivered, we simply have too many staff in the wrong place. Patient demand and models of providing care need to be more closely informing and influencing decisions about both workforce supply and design.

With the ageing population and consequential rise in chronic diseases, it is important that we really understand the fundamentals of patients’ needs and don’t, for example assume that because the location of care may change that this means the patients care needs are simpler when the reality could be that patients have very complex needs. We should also look critically at the balance between medical and nursing interventions and the scope for further extending the role of the nurse as the lead and coordinating clinicians for patients.

Historically policy has tended to focus on just one group of community nurses, for example school nurses under the previous administration and health visiting by the coalition government. Now is the time to look at the whole community and primary care nursing workforce and think about how we shape this to meet both individual and population health needs.

For example workforce statistics currently don’t include nurse practitioners or specialist nurses whereas in the future these staff should be the back bone of a workforce delivering care closer to home. The nursing profession itself also needs to take a long hard look at career structures and pathways so it is much clearer how future generations are developed to take on these roles. 

The career pathways for many newly qualified nurses tend to start in hospitals and then move into the community later in their career. Nurses are now being trained to work in a range of settings at the point of registration but there are challenges in terms of ensuring student nurses get sufficient exposure and placements in non acute settings. It is also practically harder to provide supervision and mentorship to students working in community settings as opposed to a busy acute general ward.  

Successfully developing new models of care does present major challenges to providers of services and workforce planners but also to the professions and traditional boundaries and demarcations. Health Education England and LETBs will need to get to grips with these issues as a matter of urgency and start to translate the principles of a genuinely multi- disciplinary approach and matching patient demand and workforce supply into real actions. A starting point would be to question why current commissions for medical staff continue to increase while nursing is being cut.    

The experience of many staff currently is that productivity and the Nicholson challenge are code for cuts. This fails to win hearts and minds and means staff are less likely to commit to innovation and change. Involving staff in key decision making and showing how even though a service is changing they have a future in its delivery are crucial to making the transition in care that’s required to address both future financial challenges and also delivering great high quality patient centred care.

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The Community Nursing Workforce in England