When David Cameron spoke about recruiting 5000 new GPs and strengthening primary care, but did not mention nursing once, we have to reflect seriously on why not. Louise Brady, a practice nurse and I, a former practice nurse and co-chair of the NHS Alliance, have decided to form a new general practice nurse network. We do not want it to be just about practice nurses, it will be about how others can benefit from better connections with practice nurses and vice versa. For too long, we have been hidden behind consulting room doors and there is often a level of mystery for primary care colleagues about what practice nurses do and how they can help others.
What we see over and over is that each profession and discipline has a tendency to be parochial. The NHS Alliance has a history of multidisciplinary and multiagency working and this is why we think it is a good organisation in which to promote nursing in primary care. My firm view is that good general practice is about teamwork and the heart of this is the triumvirate of GP, nurse and management working respectfully as equals.
The way to highlight a profession or discipline is not to talk endlessly to and about itself, but to sell its usefulness to others: GPs have daily contact with practice nurses and are the best at understanding this, but how can practice nurses and housing associations work together on respiratory conditions? How can practice nurses and district nurses help each other? How can secondary care consultants and practice nurses work together better to manage long-term conditions?
The nurses we have spoken to are looking for the opportunity to speak up and out about what they can do in an integrated way. The Five Year Forward View promotes the idea of GP federations and multispecialty community providers, and boundaries are in flux. I think the direction of practice nursing is therefore up for grabs – and as a non-partisan organisation, the NHS Alliance is a place where nurses can be listened to by forward-thinking GPs, patients, practice managers and pharmacists among others who are keen to hear nurses' views and echo them to national nursing organisations and policy-makers.
The second point is that money talks. Nurses are often seen as expenditure, not value. I have been impressed by how the Chartered Society of Physiotherapy (CSP) 'sells' physiotherapy. The evidence base and cost-effectiveness for physiotherapy services is spelled out. General practice nursing is a relative newcomer in workforce terms, so we need, like the CSP, to get down to brass tacks. This means cost benefit analysis of practice nurses' work, as well as assistants and advanced/specialist practitioners. As a discipline, practice nurses need to be able to quote the evidence and cost benefit ratio at every relevant meeting and CCG commissioning discussion until the message gets through.