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28.06.18

Failure to make use of executive commissioning nurses is a missed opportunity

Lorna Collingwood-Burke, chair of the Nurses’ Forum, NHS Clinical Commissioners and chief nursing officer for Northern, Eastern and Western Devon and South Devon and Torbay Clinical Commissioning Groups, discusses making use of executive commissioning nurses.

As the chair of NHSCC’s Nurses’ Forum, I hear from our members about the variation across the country in the level of involvement of nurses, particularly those in leadership roles, in the evolving NHS landscape. The executive commissioning nurse within a CCG brings a range of skills and experience for that local system, and the failure to make use of these across a wider footprint to improve service delivery for patients is a missed opportunity. Myself and colleagues are working hard to deliver integrated health and care systems and believe that there are a several unique characteristics of the executive commissioning nurse that can add value to these local discussions.

Seeing things from a system perspective

Nurses bring a unique perspective to the commissioning agenda. Our varied backgrounds, whether in acute, community, mental health or practice nursing, means we have a wealth of clinical knowledge and experience that is different to the expertise brought by our governing board clinical colleagues, who are usually from a medical background. This is important when designing services to ensure that we maximise the contribution that nurses and other non-medical professions can make to the delivery of local services.

Executive commissioning nurses undertake a breadth of statutory responsibilities for the CCG, including having the lead responsibility for assuring the quality and safety of the services that are commissioned locally, whilst others’ portfolio may also include the safeguarding of adults and children, duty of candour assurance with respect to incidents, managing complaints, leading on equality & diversity, as well as Caldicott Guardian.

This wide portfolio means that we have a clear idea of how the whole system works, and how the different elements need to pull together to deliver what is required now and for the future. We work with various and many organisations on a day to day basis – from regulators to local care homes, system-wide and local providers to third sector organisations – so we support and promote cross-organisational relationships for the CCG that are crucial to planning and delivering holistic health and care services.

This has always been important but will be imperative as the NHS continues its current direction of travel towards integrated, place-based systems of care. Executive commissioning nurses are uniquely equipped with a deep understanding of all the services and challenges across a given geography, and the relationships help to bring the right people together and make changes to bring about the best outcomes for their populations. 

Leading the way on key challenges for the NHS – finance and workforce

As we celebrate the NHS’s 70th birthday, and start to discuss how best to use the new funding announced by the Prime Minister earlier this month, inevitably we look forward to what challenges (for example finance and workforce) there are to the health service reaching its next major milestone. The latest figures from NHS England suggest that two-thirds of CCGs ended the financial year in deficit and recent analysis for the NHS Confederation estimates that the English NHS is likely to require 64,000 extra hospital doctors and 171,000 extra nurses over the next 15 years to meet growing demand.

Where I work in Devon, my governing body recognise the expertise I have; I am listened to within my own organisation and externally by providers and other stakeholders as well as our regulators. I therefore feel able to represent the voice of nurses – the largest profession in the NHS – at a strategic level. But I hear from other commissioning nurses who find it can be difficult to have their voices heard when much of their governing board’s focus is spent addressing their financial situations. Executive nurses need to feel able to participate in conversations about money, because it is central to the work they do. Simply put, if the finance isn’t right, quality will not be right either. Finance, quality and performance need to work effectively in order to keep our patients and populations safe.

The whole-system perspective that executive commissioning nurses have, means they have an holistic view of all the services and the challenges they face, such as workforce, so are often best placed to advise the rest of the governing body on how they might be addressed. They also are uniquely equipped to advise and provide support to the implementation of workforce strategies, whether at CCG or STP level.

The NHS is rapidly moving closer towards place-based models of care, and a new infographic from NHS Clinical Commissioners, the independent membership body for clinical commissioners, demonstrates the key role the executive commissioning nurse can play in this system.

 

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