The Royal College of Nursing District Nursing Annual Conference Community Nursing evolution not revo

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The Royal College of Nursing District Nursing
Annual Conference Community Nursing evolution
not revolution

• The Future of an Advanced Practice Workforce
• Professor David Sines
• September 20th 2006

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The Stimulus for Change

• Both the profession itself and the Government
  have recognised that major cultural change is
  required in the health service and confirmed that
  changes in health reform and education should
  contribute to that change.

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The Challenge

• This is a time to renew our commitment to examine
  critically the very essence of the philosophy of
  care that underpins our practice as community
  nurses. This will require a fundamental review of
  competence, fitness to practice and of our
  fitness for purpose.

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The Modernity Agenda

• A significant aspect of the modernity agenda
  requires the professions to develop robust
  competence based frameworks to underpin their
  practice. This will inspire public trust and
  confidence in our products, governed by
  systematic and well tested regulatory systems and
  procedures.

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Responding to the Context of Care Delivery

• New provider functions inter-sectoral
• Redefining the health care contribution
• Redefining the social care contribution
• Working with high risk or people who present with
  enduring complex needs
• Promoting positive public health
• Protecting the Public!

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The Policy Context

• Creating and Commissioning a Patient Led NHS
• Choosing Health
• Promoting Choice between care providers
• Social Enterprise, including Practice Based
  Commissioning
• Our Health, Our Say ..
• Regulation - Foster!!
• What does the public expect of us?
• What do our employers expect of us?

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A Change in Emphasis

•   Shift in the shape of the workforce in primary
  care Practice Based Commissioning
•    Shift in how staff will be rewarded from
  remuneration based on qualification towards a
  more flexible approach that rewards the
  acquisition of skills and knowledge relevant to
  the role.
•   Supporting specialisation at all levels of the
  workforce as well as the development of high
  level generalists.

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A Change in Emphasis - 2

•   Staff who are prepared to work across
  traditional boundaries at all levels
•   Moving away from a professional title focussed
  service to one that offers practitioners
  preparation in a range of eclectic domains
•   A flexible career structure that enables
  progression to occur following evidence of
  competence to practise.

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Breaking with Tradition

• Inter-professional collaboration
• Expert Patients and Carers
• User and Carer Advocacy
• Alternative service providers/employers
• Targeted Approach
• Integrated Case Management to co-ordinate care
  packages and interventions across all health and
  social care providers in acute and primary care
  settings

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Education and Training

• Assistant Practitioner Roles
• Pre-Qualifying Primary Care Education programmes
• A new responsive Professional Development
  Framework for Primary Care populated by study
  days, modules and programmes
• Advanced Nursing Roles to replace PIQs
• Specialist Community Public Health Nursing
• Mentors and Practice Educators
• Preparing expert commissioners!

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Six Key Roles!

• Expert Practice linked to Therapeutic Groups and
  Protocols (including Prescribing, Diagnosis and
  Advanced Practice)
• Public Health Champions
• Resource Management and Case Management
• Strategic Leadership
• Commissioning
• Social Entrepreneurship

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The Ultimate Gateway

•    The ultimate gateway would be for primary
  care staff wishing to demonstrate their ability
  to become advanced/specialist practitioners.

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Revalidation of Competence to Practise

• By the end of this year all nurses who profess to
  hold, or use advanced nursing qualifications and
  titles will have to provide evidence of their
  compliance with a new set of competencies that
  will be regulated by the Nursing and Midwifery
  Council.

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Revalidation of Competence to Practise - 2

• The new advanced nurse practitioner standard will
  ensure that only those nurses who have
  successfully completed postgraduate advanced
  practice courses will be able to practise as
  advanced practitioners. This heralds a major step
  change in the professions claim to
  self-determination of its standards and will
  provide nurses with the acknowledged right to
  assume new roles and responsibilities.

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Revalidation of Competence to Practise - 3

• Of equal importance will be requirement for all
  nurses who use titles such as nurse
  practitioner, specialist practitioner or
  independent care practitioner to demonstrate
  compliance with the Councils new advanced
  practice standards.

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Patient and Public involvement.

• There are both moral and practical arguments for
  involving the users of public services in their
  regulation. Public services are, by definition,
  services for the public good, using public money.
  The public therefore has a dual stake, both as
  the funder and user of such services. It is
  therefore morally right that we, the public,
  should have some say in how the services are run
  and how the people who provide the services are
  regulated.

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Adapting the Key Principles

• Whilst no standard model can be prescribed, the
  introduction and implementation of sound
  infrastructures for the regulation of the nursing
  profession has been proposed. It is hoped that
  these may be adapted to suit local conditions and
  national requirements.

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A Global Framework for Practice

• This paper has considered some of the main issues
  to be addressed in the design and introduction of
  a global framework for the regulation of
  professional practice. Its roots are firmly
  established in the evolutionary nature of
  professional development in community nursing and
  recognise the innovative, adaptable and flexible
  nature of the practitioners themselves.

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Assumptions

• Regulation of Assistant Practitioners
• Defining competencies for each progression point
  on the continuum.
• Ensuring Workforce Development groups work with
  HEIs and PCTs to offer flexibility in education
  commissioning to enable move from traditional
  specialist practice
• PBC realised.

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Conclusions

• Emerging view of what constitutes the effective
  regulation of advanced professional practice
• Need to move beyond broad and fairly unarguable
  principles to more practical, operational ideas
• Need for a stronger empirical foundation for
  those ideas not just assertion/belief

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A Tri-Partite Responsibility

• Finally, it is my contention that the realisation
  of excellence in the design and delivery of
  reformed community nursing services relies upon
  the principle that both the public and their
  professional carers require (and deserve) mutual
  recognition as key stakeholders in the
  development and implementation of future policy
  imperatives that aim to shape and influence the
  nature of our practice base and governance
  arrangements.

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