Changes ahead for Northern Ireland’s community and primary care nurses

Northern Ireland’s Health Minister Michelle O’Neill has committed to tackle the issues faced in the health and social care system, and nurses have a vital role to play, says Charlotte McArdle.

Nurses have a vital role to play in Northern Ireland health and social care reforms, says Charlotte McArdle

Nurses have a vital role to play in implementing changes in the health and
social care system report. Picture: Crispin Rodwell 

Northern Ireland’s Health Minister Michelle O’Neill has set out a commitment to tackle the issues faced in the health and social care (HSC) system in her report, ‘Health and Wellbeing 2026: Delivering Together’.

The document set out the need for change, and aims to create a new model of person-centred care, which will improve a service that Ms O’Neill says is ‘at breaking point’. It includes a requirement to develop innovative primary care-based models that will allow non-medical staff to work in a way that makes the most of their skills.

The minister recognised that clinical and social care staff are working harder than ever before but working in a system lacking the ability to provide 21st century care. As the largest HSC workforce, nursing is central to realising a vision for change. This is a fresh start for the HSC system and there are a number of significant developments that will enable Ms O’Neill’s ambition to be realised.

Under pressure 

GP practices and community services are under immense pressure, and workforce challenges mean we need to do things differently. This is where nurses can be part of the solution. I am even more convinced of this having visited the wonderful Cuckoo Lane practice in Ealing, a primary care practice run by two nurse partners. It works well because staff are supported and enabled to develop their clinical skills to enhance the experience and outcomes of care.

The Advanced Nurse Practitioner (ANP) role enables this to work well, and we need to develop this role across primary and out of hours care. Primary care can only work if delivered by a true multidisciplinary team. The ANP provides complete care for patients from assessment to diagnosis and treatment, underpinned by the Nursing and Midwifery Council’s code and within a defined scope of practice.

When dealing with patients with long-term conditions, ANPs have the ability to use their advanced knowledge and skills to take patient history and physical examinations, interpret findings, assess risk, prescribe medication and refer. These skills differentiate them from other nursing roles. In practice, ANPs enable GPs to work at the top end of their practice and provide quicker access to complex conditions. Ms O’Neill has commissioned the first-ever ANP programme, targeted specifically at primary care and emergency departments, and beginning in spring 2017.

Continual change 

District nurses are integral to this transformational agenda, and promotion and identification of their unique role is essential. District nurses working in community teams providing acute care at home have been able to demonstrate reductions in ED attendances and hospital admissions, as well as providing holistic care and a better experience for patients. We are exploring evidence-based methods of providing a sustainable district nursing service through Delivering Care, our policy for ensuring the appropriate nurses are in the right place and through exploring a Dutch-style model of care.

Nurses are used to working in a context of continual change, challenging environments, growing diversity and rapidly evolving technologies, yet the pace of change has speeded up. Greater integration of HSC services requires negotiation across a range of boundaries. There is also a requirement to manage the care of people with a range of needs while showing equal regard for identifying and meeting mental, physical, cognitive and behavioral challenges.

Nurses have a vital role to play in realising the change set out by Ms O’Neill. The opportunities to make an impact on the lives of people we care for have never been greater.

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Professor Charlotte McArdle is Chief Nursing Officer, Department of Health, Belfast 

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