1. Primary Care Nurses: engaging and leading service redesign Marilyn Eveleigh PCT Head of Clinical Performance & Lead Nurse Consulting Editor ‘Nursing in Practice’ January 2008

2. Why would we think that? Political messages Care closer to home Redesign local services Commissioner for Carers Modernising Nursing Careers Wanless report ‘Our Future Health Secured’

3. National announcements always have a local interpretation

4. Providers of services Walk in centres Public health projects Terence Higgins HIV/chlamydia screening OOH street first contact care Out of hours care/Urgent care centres Community matrons HCAIs NHS Direct

5. Are nurses leading models of care? PMS independent contractor Social enterprise organisations Referral centres Private practice Independent nurse consultants

6. Nurses in commissioning Professional Executive Committee [PEC] Cost/quantity Few providers Tariff [PbR]

7. Practice Based Commissioning Nurses are needed to INFORM Poor involvement nationally Not welcome? Not confident? Not knowledgeable? Not available? Not paid?

8. Future of commissioning Separate provider function Variety of potential providers incl. PBCs Patient engagement Determine quality/governance/standards Close monitoring ‘World class commissioning’: prevention

9. Nurses in primary care Monopoly of CDM & screening Integrated into GP independent providers Have developed a business mind Have made the generalist a specialist Developed a career pathway: WIPP Training providers grown to serve

10. Constraints? Few entrepreneurs Pioneers without role models Financial backing Limited business skills Indemnity Shielded by NHS infrastructure But success of nursing homes? New extending roles of GPs

11. Primary & community care providers SPECIALISM plus….. Wide but shallow knowledge base Referral skills/pathways/contacts Competencies for caseload Public health emphasis Safe premises & standards Lone working

12. Implications for educational providers? Reforms bedding down Uncertainty what/how to provide Local variations New workforce not clinicians: behaviour changers New providers?

13. 5 suggestions….. 1.Rapid response to service needs 2.Flexible entry and outcomes 3.Appropriate times and timescales 4.National partnerships: cumulate credits, common credit value, franchise courses 5.Develop training practices/centres

14. A priority? Embrace Practice Based Commissioning