In recognition of the large volume of comments received in response to the draft report of the Review of Nursing in the Community and the concerns reflected by many, it was agreed that it would be useful to summarise the main themes from the responses. Some of the concerns reflect the lack of detail of this strategic paper and how the proposed model would be operationalised in practice and these will be worked through during the implementation process. Issues raised have been taken into consideration in the subsequent redraft of the Report.
The majority of the analysis of the responses received up to the closing date of the consultation was conducted by an independent researcher. Further analysis of the remainder of the responses that came in after the closing deadline was undertaken internally. The responses reflect the comments from a wide variety of sources including all Boards (including Nurse Directors, and Chief executives) Higher Education Institutions, GPs, practitioners, the steering and practitioner groups, users and carers as well as professional organisations and bodies such as the Nursing and Midwifery Council. More than 160 replies were received from individuals from every area in Scotland. Over half the respondents worked in or represented NHS agencies or staff. There were also a sizeable number of responses from individuals representing multi-agency partnerships, such as Community Health (and Social Care) Partnerships. Most of the responses displayed considerable awareness and knowledge of on-going initiatives aimed at improving the delivery of community-based services in Scotland.
Respondents acknowledged the effort that had gone into the Review of Community Nursing and many commented positively on a number of aspects of the review report. However, although respondents were largely in support of the report's key messages and recommendations, there were a number of serious concerns expressed about the model.
Some of the main themes which have been identified in the responses include:
- The move towards generic skills vs. specialisation among community nurses (jack of all trades with the associated dilution of skills and loss of specialist skills, master of none)
- The "clinical" nature of a model which endeavours to give equal weight to health promotion and prevention and clinical care of unwell patients with concerns that inevitably the needs of the sick individual would override the health promotion work
- The uni-disciplinary focus on nursing vs. a focus on multi-disciplinary integrated services
- The impact of such radical proposals on the morale of an already demoralised, change fatigued workforce with concerns that some would leave the nursing profession
- The place of children and young people within the proposal with particular concerns around child protection issues
- The place of Practice Nurses within the model and lack of acknowledgement of their central role in managing Long Term Conditions etc
- A lack of evidence for the recommendations and proposed model
- Concerns about the transferability of qualifications between Scotland and the other UK countries and vice versa
- The inadequate consultation time around the recommendations and proposed model for such far-reaching changes
- A lack of awareness or acknowledgement in the report of the wider policy context and other national initiatives
- Geographical based teams vs. attachment to a primary care practice.
- Training and competencies of nurses both initially and maintaining skills for the new role with consequent concerns around patient safety
- Management issues - particularly how the consultant nurse role fits within the CHP structure and the CHP Lead Nurse along with the affordability of the proposed new structure
The Final Draft of the Report is now being reviewed by SEHD officials. No further updates will be provided until the outcome is known.
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