The role of the community nurse in primary care led commissioning

Primary care policy and practice in Northern Ireland is unique for two main reasons: unlike elsewhere, Northern Ireland has an integrated health and social services system and the primary care reforms witnessed in many countries have not, as yet, taken place in Northern Ireland. This paper is based on a study in Northern Ireland that aimed to review the role and function of community nursing with reference to new developments in practice, education, research and policy. Service commissioning was one of many areas explored within the study and is the main focus of this paper. The study commenced with focus groups of community nurses (n = 38), general practitioners(GPs) (n = 14) and public representatives (n = 8). This was followed by a two stage Delphi investigation using self-report questionnaires. In addition, data from 34 senior policy makers were collected using semi-structured interviews. The research was primarily carried out in Northern Ireland but involved GPs, community nurses and members of the public from the Republic of Ireland. Findings from all these data sources suggest that there is a perception that community nurses do not have the skills to take a lead role in the commissioning of services, that they require intensive training to take on such roles, and those who do should have equal remuneration with GPs who are involved in service commissioning. Recommendations are offered in the form of action points to guide future practice and policy.