Clinical commissioning groups (CCGs) need to understand the added value that nurses bring to the commissioning table and how this benefits patients. But as the debate continues over the tokenistic requirement to have nurses on CCG boards, there is a danger that GP commissioners will miss the point.
Unlike the expertise that, for example, accountants bring, it is not as easy to see that nurses' input is going to be beneficial.
Commissioning is a complex task demanding creative problem-solving and risk management based on professional experience. A multidisciplinary approach will achieve the best outcomes for patients as nurses, doctors and allied healthcare professionals are all trained to see different aspects of the human condition.
Integrating care demands strong relationship-building skills and partnership working. These skills are bread and butter to nurses. This is the case whether a health visitor is discussing safeguarding concerns with parents prior to a referral to social services while being able to maintain a relationship with that family. Or whether a district nurse is managing conflicts that may occur during interagency and/or family discussions about an elderly patient wishing to die at home.
The skills needed to reach a consensus in such situations are as valuable in the boardroom as in frontline care.
CCG boards need individuals who can contribute specific expertise to the task of agreeing provider contracts as well as performing the corporate and strategic role required from all board members.
For example, how many GPs know about the NHS Institute for Innovation and Improvement's 10 high-impact actions for nursing in sufficient detail to develop metrics that could be reflected in the commissioning for quality and innovation (CQUIN) payment framework? CQUIN acts as a carrot or stick by allocating financial rewards or, if required outcomes are not delivered, penalties.
How many GPs are fully aware of the Energise for Excellence and Productive Ward programmes or that particular criteria relating to nurse staffing, development and job satisfaction link directly to improved patient outcomes? All are important quality initiatives to reflect in negotiations with providers.
Finding the nurse with the right skills and expertise to deliver this role effectively is likely to be difficult. However, the NHS Alliance has developed a Nurses in Commissioning Network to help CCG boards and individual nurses understand this role, and to develop the skill set needed to maximise their impact.
- Yvonne Sawbridge is co vice-chair of the NHS Alliance and a senior fellow of the Health Services Management Centre, University of Birmingham