How Can UK Obesity Strategy Succeed If Frontline Nurses Feel Undervalued?

Main Category: Obesity / Weight Loss / Fitness
Also Included In: Primary Care / General Practice
Article Date: 28 Jan 2008 - 1:00 PDT

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Health Secretary Alan Johnson and Schools Secretary Ed Balls have just published a £372m plan aimed at reversing the spiralling problem of obesity.

Primary care nurses work on the frontline of healthcare, and are often the first contact for individuals wishing to lose weight. They offer treatment, diet and lifestyle advice as well as much-needed support to the overweight and obese. They are vital to the success of any obesity strategy. Health visitors alone have a huge influence over the early years, helping parents and families to lead healthier lifestyles.

However, a survey by Nursing in Practice of over 1,400 primary care nurses has revealed that staff shortages, frozen PCT (Primary Care Trust) posts, an increasing workload and little recognition of the value of their role have left many primary care nurses disillusioned with the state of their profession.

In fact, the survey reveals that 62% of health visitors describe their current morale as low, 36% feel the amount of work-related stress they experience is "unmanageable", and more than half - 60% - would not even recommend a career in the primary care sector, worrying figures for the government who will be relying on this profession to underpin the new strategy.

Unite/CPHVA Acting Lead Professional Officer Cheryll Adams said: "It is enormously worrying, but predictable, that 60% of those polled would not recommend a primary care sector nursing career - and this is a searing indictment of very poor NHS management philosophies which have allowed this culture to develop." Unite/CPHVA (Community Practitioners' and Health Visitors' Association) is a section of Unite, the third-largest trade union in the NHS.

Survey results also showed that it is not just health visitors who are feeling discontented - 55% of district nurses and 45% of community nurses would also describe their current level of morale as low.

Lynn Young, Primary Care Adviser at the Royal College of Nursing, is not surprised by the survey results: "Community nurses and health visitors are tired of constant organisational change, which in itself achieves little improvement in patient care. In fact, quite the reverse - public funds are used to support irrational change, rather than frontline services."

For practice nurses, the ticking-box process involved in achieving QOF (Quality and Outcomes Framework) points - the annual reward and incentive programme detailing general practice achievement results - was the biggest complaint.

One practice nurse described how "number-crunching has taken emphasis away from giving the patient quality care", while another expressed disgust that, to achieve maximum points, "a patient should be rung up by a HCA [Health Care Assistant] and asked if they are feeling suicidal, or when they last had an epileptic fit".

Pay was another emotive subject, with most primary care nurses feeling underpaid and undervalued:

64% of district nurses felt their remuneration was "unfair" and that, as specialist practitioners being shouldered with more and more responsibility, they should be on Agenda for Change (AfC) band 7 or even 8, earning the equivalent salary of a head-of-year teacher or police sergeant.

56% of health visitors said they were paid an unfair wage and that, considering the responsibility and accountability that came with the job, all health visitors should be AfC band 7.

52% of community nurses considered their remuneration to be "unfair", with most feeling that AfC band 6 would be more appropriate for their level of responsibility.

53% of nurse practitioners in primary care considered their remuneration "unfair". As one nurse practitioner said: "I see patients with undifferentiated and undiagnosed conditions, I am a nurse prescriber and I do not think AfC pay bands reflect clinically on this level of work." Most were looking to be on AfC band 8.

However, in contrast, and perhaps because they are not paid by the NHS (they are paid directly by GP employers), 61% of practice nurses felt that their remuneration was "fair" and reflected their current workload and level of responsibility.

"Comments made [in the survey] by PCT-employed nurses on pay are harsh, making the RCN even more aware that a 2008 pay deal needs to be far more generous than that awarded in 2007," said the RCN's Lynn Young.

This was echoed by Nursing in Practice Editor-in-Chief Elaine Linnane: "We are keen to investigate our readers' views and feelings and to represent them and their interests in our media and the media at large. That's why we took advantage of our large readership to canvass their opinions in the survey and obtain a true representation of them. Yes, we aim to promote best practice and improve patient care. But we also feel it important to reflect the nurses' views and interests and bring them to the attention of the media and hence the public and the powers-that-be with a view to improving their working lives too."

You can read the full article online here.

Notes:

The Nursing in Practice Survey was conducted online at http://www.NursingInPractice.com from 14 November to 7 December 2007. A total of 1,477 primary care nurses completed the survey.

Other results included:

- 30% of practice nurses, ð ð40% of district nurses, ð ð52% of health visitors and 24% of community nurses are planning to retire in the next 10 years.

- 53% of health visitors felt that patient care had worsened since the PCT changes, and 36% of district nurses agreed.

- 60% of community nurses do not undertake regular clinical supervision (as defined by the NMC: Nursing and Midwifery Council).

- 10% of district nurses would like a career change as soon as possible.

- 28% of practice nurses, 21% of community nurses, 40% of health visitors, 23% of nurse practitioners and 12% of district nurses are unclear about what exactly "practice-based commissioning" means.

Out-of-hours care: 50% of community nurses, 52% of health visitors and 57% of district nurses believe that we should go back to the pre-2004 arrangements, and money should be reinvested in general practice to allow GPs to support out-of-hours care. However, 74% of nurse practitioners and 65% of practice nurses believe that the 2004 out-of-hours arrangements have had mixed results, but that PCTs should continue to provide the service and improve upon it where necessary.

About Nursing in Practice and Campden Media

Nursing in Practice is a bimonthly review journal produced by Campden Publishing that delivers accessible, relevant and informed news, in-depth articles and comment on modern nursing practice in primary care. It is part of a family of products and services including events, exhibitions, online content and recruitment. All these products are specifically designed for practice nurses and other primary care specialists working across the UK and aim to promote best practice and thus improve patient care.

NursingInPractice.com is a free online service designed to complement the Nursing in Practice magazine. Visitors to the site can get daily news online or delivered direct to their inbox by email each week. In addition to news, there is also a complete archive of all past issues of Nursing in Practice, regular online comment, a weekly quiz and many other features, including video presentations from our latest live events.

Nursing in Practice Events is the largest free conference and expo series designed specifically to meet the educational needs of practice nurses and other primary care specialists. Each programme features an impressive collection of speakers delivering highly topical and relevant presentations that contribute to attendees' professional development. These educational conferences are complemented by an exhibition featuring key charities, product suppliers, educational institutes, services for primary care and recruitment specialists. In 2008, Nursing in Practice Events will be visiting:

Belfast - King's Hall - Wednesday 6 February 2008

Glasgow - SECC - Tuesday 11 March 2008

Cardiff - Cardiff International Arena - Tuesday 8 April 2008

Newcastle - Newcastle Racecourse - Wednesday 23 April 2008

Manchester - Bridgewater Hall - Tuesday 20 May 2008

http://www.nursinginpractice.com/london- Tuesday 23 and Wednesday 24 September 2008

Birmingham - NEC - Wednesday - 19 November 2008

Campden Publishing is a division of Campden Media , a specialist business-to-business information provider. The company delivers essential information in two core markets - finance and healthcare. Our brands create high-quality content that is delivered to our audiences via the combined channels of print, online, research, conferences and exhibitions. Campden Media is a global organisation with offices in London, New York and Singapore.

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