NURSING Associates have been given the go-ahead to administer drugs, unsupervised, to the alarm of the nurses’ union RCN.
NHS to train 2,000 new Nursing Associates to administer drugs unsupervised and monitor the sickest patients, nurses were rightly extremely concerned. Rather than address the staffing crisis by recruiting and training more nurses, the government now wants to palm nursing tasks off to unqualified Nursing Associates.
Nurses are being driven out of the profession because of overwork, low pay and the removal of the NHS student bursary, which up until now enabled nurses and midwives to study for free. The training for the first batch of Associates will begin in January at 11 sites.
They will be given the responsibility to determine the correct medicines and the correct dosage at the correct time. The leaked document, obtained by the Health Service Journal, outlines the plans for Nursing Associates to deliver hands-on care for patients.
Calculating drug doses and independently administering controlled medicines is a highly skilled task. Any mistake could have deadly consequences. Janet Davies, RCN Chief Executive & General Secretary, said: ‘The Nursing Associate role must not be a substitute for registered nurses, who are required to make clinical judgements using a high level of experience and knowledge to assess complex situations.
‘Nurses are responsible for the wellbeing of their patients and this includes delegating some tasks to other members of staff. Part of their professional accountability involves making a judgement over when it is safe to delegate responsibilities to colleagues.
‘To continue to do this properly they will need much more clarity over the roles and responsibilities of Nursing Associates. Safe administration of medicines is a key patient safety issue.
‘Drug administration is not a mechanistic task – it requires professional judgement, and if ongoing assessment of a patient is required it should be the responsibility of a registered nurse. If unregistered staff are expected to do tasks which have previously been carried out by registered graduate nurses, this risks placing an unfair burden on them and reducing patient confidence in the health service.
‘The introduction of nursing associates can be an opportunity to provide support to registered nurses and improve care for patients. However, there must be no ambiguity about how the roles overlap, and all staff should be given responsibilities that are appropriate to their skills and experience.’
• Some 27,000 patients are at risk of losing their GP practice as a provider has decided to hand back a contract it says is ‘not fit for purpose’. Greenbrook Healthcare, which runs five practices in west London under one APMS contract, said it has been in discussions with NHS England since the beginning of the year to ‘address what support could be provided by them’.
But with no extra funding coming through, Greenbrook Healthcare, a private company which runs GP practices and urgent care centres across west and south London, has concluded that the best option is to end its 10-year contract nine months early, to ‘allow NHS England to look at the contract afresh.’
The provider said that ‘over time’ the contract covering the Hounslow-based Bedfont Practice, Manor Practice, Great West Surgery, Heston Practice and the Isleworth and Grove Practice has ‘become unfit for purpose, on the back of increasing demand and the GP recruitment crisis.’
A spokesperson said: ‘Demand has increased, and the national shortage of GPs has made finding GPs ever harder.’ Greenbrook Healthcare said it expects NHS England to re-tender the contract for running the practices in July next year, and that it would have to look in detail at the terms before deciding whether to renew its bid to run the practices.
It added that it would try to mitigate the impact of any changes to provider. The spokesperson said: ‘In the scenario that a new provider takes over these services Greenbrook Healthcare will do everything it can to keep the impact on patients to a minimum, and to ensure high quality patient care remains a focus through to the end of the contract and beyond. In addition, doctors, nurses and other staff would transfer to any new provider (under TUPE rules) minimising any changes that patients may experience.’
Greenbrook Healthcare took over the management of the practices from Hounslow Primary Care Trust in 2008. It says that it ‘has made considerable investment in the quality of the care delivered in these practices, greatly increasing the opening hours, the number of services offered and improving quality metrics such as QOF scores.’
A spokesperson for NHS England said: ‘Greenbrook Healthcare has given nine months’ notice on their contracts in Hounslow and the contracts will now terminate at the end of June 2017.
‘We will be communicating with all affected patients shortly to ensure that they have their say on the future of their GP services in the coming weeks. We are working to ensure that disruption is minimal and we want to reassure patients that we will do everything we can to find a solution that provides the best possible care for the local community.’
Last month it emerged that some NHS managers are proposing to allow vulnerable GP practices ‘to fail and wither,’ because they are closing while still waiting on the government’s support funds.
• The full extent of the pressure on the NHS is not being recognised by the government, MPs have warned. Members of the Commons health select committee – including Conservative MP and committee chair Dr Sarah Wollaston – have written to the chancellor urging him to provide more investment in his autumn statement.
The letter calls for capital resources to fund the Sustainability and Transformation Plan process. This claims to ‘ensure the long-term survival of the NHS, to address the crisis in social care provision and for the government to reconsider the NHS funding settlement so the service can meet spiralling demand.’
However critics say this is just a front for more cuts. The letter says: ‘Our fear … for the NHS over the spending review period, (is that) these short-term pressures will become overwhelming. Ahead of the autumn statement we wish to make two requests of the government. The first is that it seriously considers a means of increasing the capital funding available to the NHS. The second is that the government respond to the crisis in social care provision.’
The letter, also signed by Labour’s Ben Bradshaw and Emma Reynolds, Tory James Davies, and the SNP MP Philippa Whitford – who also sit on the committee – criticises health secretary Jeremy Hunt and prime minister Theresa May’s suggestion that the NHS has been given £10bn of extra investment.
It says the claim is ‘not only incorrect but risks giving a false impression that the NHS is awash with cash’ and puts at risk the achievement of the Five Year Forward View’s aims to make services sustainable – with money being diverted from areas like public health and social care to account for the figure.
It comes just a week after health secretary Hunt was called to speak to the committee’s inquiry into the sustainability of the NHS. He told them: ‘Whether you call it £4.5bn or £10bn, it doesn’t matter. It is what the NHS said they needed and it was extra money going to the NHS frontline.’
In response, Dr Wollaston made clear that she and her committee believed that continued use of the £10bn figure was misleading, while Bradshaw said the government’s investment had come at the expense of slashed public health and social care budgets.
BMA council chair Dr Mark Porter said the BMA has long been urging this government to be honest about NHS funding. He said: ‘Our calls are now being echoed by experts and interested parties from all sides of the political landscape. The prime minister and chancellor need to explain how exactly the NHS will keep up with rising demand without the necessary investment.
‘Theresa May talks about injecting £10bn into the NHS, yet in reality the increase in health spending is less than half of that. The NHS is already the most efficient healthcare system in the world. The notion that the funding crisis can be solved with further efficiency savings is a myth, and these are not savings, they are year-on-year cuts that have driven almost every acute trust in England into deficit, led to a crisis in general practice and a community and social care system on the brink of collapse.
‘The NHS needs urgent action to put it on sustainable financial footing. Failure to invest now will result in a disaster in the future, both financially and in terms of patient health and care.’
