Opinion

Let's break down the old professional boundaries, then embed this approach in practice

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NHS England chief executive Simon Stevens’ Five Year Forward View, and recently published action plan for its implementation, represents a profound and transformational strategy for the NHS.

If implemented across the health service, the proposed new care models will reorganise NHS services for the next generation. The first Vanguard pilot sites have been announced with £200 million prime-pump funding, and evaluation of their success will follow soon after.

Sceptics have suggested that such extreme change is unlikely to be achievable in the five-year timescale set out, especially against the back drop of a general election in May, enormous financial pressures on the NHS and social care system, and serious deficits in leadership capacity and workforce to deliver the new care models.

This is where the learning and expertise available in institutions like the University of Southampton can add value. Normalisation process theory (NPT), developed by my close colleague Professor Carl May, tells us about the attention we need to pay to the process of implementing new services or processes.

The biggest obstacle to change is not the lack of resources, new ideas or technologies, but people. Changing the behaviour of clinicians such as nurses, doctors and allied health professionals is difficult, slow, and time-consuming. We work in highly routinised ways that can be characterised as ritualistic, often driven by deeply embedded cultures and practices that are core to a particular professional discipline or speciality.

The delineation between which professional group does what, and how, is still greatly restricted by professional norms and history. Many of the practices that are considered mainstream and essential have not been scrutinised for their effectiveness, or indeed necessity, in the context of the Five Year Forward View.

NPT would tell us that new technologies and ways of working need to be embedded into practice; they need to be rehearsed, moulded into care processes, and become normalised.

Inertia is handed down as history, and as a nurse, and someone who has spent a long career driving change better to support people in healthcare services and institutions, this is a source of profound frustration to me.

But the Five Year Forward View provides a significant opportunity for whole-system and large-scale change. This has made me contemplate what, from the point of view of a nurse, could have the most profound effect to drive change.

Professor Sue Latter, another close colleague here at the University of Southampton, led the original evaluation of non-medical and later independent prescribing, demonstrating the safety and acceptability of extending full rights of prescribing medicines to appropriately trained nurses, pharmacists and, more recently, other health professionals.

There are now around 21,000 non-medical independent prescribing nurses and pharmacists in the UK who are quietly mobilising nothing short of a revolution in the health system. They are shifting professional demarcations of who has the responsibility to initiate treatment for patients, and dramatically reducing the number of clinicians patients have to see, to effect disease management or symptom control interventions in hospitals and in the community.

We now need to harness the skills of nurses and allied health professionals in clinical assessment, diagnosis, and prescribing, and embed and normalise these into caring roles as a major part of Simon Stevens’ vision.

About the author

Jessica CornerProfessor Dame Jessica Corner is dean of the faculty of health sciences at the University of Southampton
www.southampton.ac.uk/healthsciences