Contents
Contributors, x
Preface, xii
1 The Context of Primary Health Care
Nursing, 1
The changing context of service
provision, 1
The primary care vision for the next
decade, 3
The impact of primary care policy
changes on the role of the primary
care nurse, 7
The scope of primary care nursing
practice within the context of a
changing workforce, 9
International infl uences on the health
care agenda, 12
Conclusion, 13
References, 15
2 Social Policy, 17
Introduction, 17
The policy-making and implementation
process, 17
The evolution of the NHS, 21
Health care under the Conservative
Government 1979–1997, 22
Labour Government health care
policy, 24
Conclusion, 29
References, 30
3 The Origins of Contemporary Primary
Health Care, 33
Introduction, 33
Primary health care – the concept, 33
Primary health care and the NHS, 36
Primary health care in the
community – key issues and
initiatives, 39
Looking to the future, 44
References, 45
4 Community Development in Public
Health and Primary Care, 48
Introduction, 48
The current context for community
development practice, 48
Defi ning the terms, 50
Making it work – key issues in successful
community development, 55
The role of community health
professionals, 57
Conclusion, 59
References, 59
5 Health Needs Assessment and the
Community Nurse, 61
Introduction, 61
Background and policy context, 61
Defi ning health needs assessment, 62
Perspectives of health and need, 63
Reasons for and benefi ts of
conducting health needs
assessments, 64
Challenges associated with health needs
assessments, 65
The process of carrying out a health
needs assessment, 66
Participatory approaches, 69
The role of the community nurse, 70
Conclusions, 71
References, 71
6 Research Perspectives Applied to Primary
Health Care, 74
Introduction, 74
Priorities for nursing and health care
research, 74
The knowledge base for public
health and primary health care
practitioners, 78
Refl ective practice and research
mindedness, 79
The research process, 80
General research issues, 91
Conclusion, 95
References, 97
7 Health Visiting, 102
Introduction, 102
The development of the profession, 102
Public health and health visiting – 1970s
onwards, 103
Modernising the role of the health
visitor – a public health approach, 104
Modernising nursing careers, 106
The health visiting review 2007, 106
Facing the future: the government
response, 107
Family nurse partnership programme, 107
The updated CHPP (DH 2008), 108
Challenges and opportunities for health
visiting practice, 108
Public health and health visiting
practice, 110
The way forward, 112
Conclusion, 114
References, 114
8 General Practice Nursing, 117
Introduction, 117
Historical development of practice
nursing, 117
The impact of policy and General Medical
Services (GMS) contracting on
practice nursing, 118
Practice nursing – roles and functions, 121
Long-term conditions management, 127
The future, 131
References, 132
9 Contemporary Issues in District
Nursing, 134
Introduction, 134
Historical origins, 134
The changing primary care workforce, 135
The changing role of the district nurse, 137
Practice-based commissioning, 139
Clinical governance, 139
Managing long-term conditions through
population management and a
geographical perspective, 140
Non-medical prescribing, 142
Continuous professional development –
lifelong learning, 143
Responding to the changing policy
context, 143
Conclusion, 145
References, 146
10 Community Children’s Nursing, 148
Introduction, 148
Every Child Matters, 149
National Service Framework for Children,
Young People and Maternity Services, 151
Our Health, Our Care, Our Say, 152
The Next Stage review, 152
Better Care: Better Lives, 154
Aiming High for Disabled Children, 155
The community children’s nursing
workforce, 156
Band mix in the registered
community children’s nursing
workforce, 158
New ways of working, 159
Advancing practice, 161
Non-medical prescribing, 162
Modernising Nursing Careers – educating
a workforce that is fi t for the
future, 163
Support workers in the context of
community children’s nursing
practice, 164
Transitions from children’s to adult
services, 166
Conclusion, 168
References, 168
11 School Nursing, 172
Introduction, 172
Children as the future, 172
Placing education high on the agenda, 172
Emphasis on public health for school
health, 173
Establishing the number of school
nurses, 174
Education and training, 175
The future, 176
The public health role of the in school
nurse, 176
Leadership and organisation, 179
Mental health – a specifi c issue, 180
The need for marketing, 181
Conclusion, 182
References, 182
12 Occupational Health Nursing, 185
Introduction, 185
Occupational health nurses as specialist
practitioners, 185
Historical perspective, 187
Provision of occupational health services
in the UK, 188
The changing nature of UK workplaces, 189
Changing work patterns, 190
Workplace practices, 190
The domains of occupational health
nursing practice, 191
The educational domain of practice, 194
Public health strategies, 194
Specialist community public health
nursing – part 3 of the Register
maintained by the Nursing and
Midwifery Council, 195
Conclusion, 195
References, 195
13 Community Mental Health Nursing, 197
Introduction, 197
A guiding paradigm, 197
The National Service Framework, 199
The principles of community mental
health nursing, 199
Conclusion, 213
References, 213
14 Community Nursing Learning
Disability, 218
Introduction, 218
People with learning disabilities, 218
The number of people who have
learning disabilities, 219
Changing service principles – but
what progress?, 220
Time to refl ect?, 222
Moving forward, 223
The health of people with learning
disabilities, 224
What community nurses for people
with learning disabilities do – the
emerging evidence base, 226
The future role of community nursing
services for people with learning
disabilities, 229
Conclusion, 231
References, 231
15 Advanced Nursing Practice in the
Community, 234
Introduction, 234
Why advanced nursing practice?, 234
What is advanced nursing practice?, 235
Do titles matter?, 241
Nurse practitioners – history and
development, 241
The community matron – history and
development, 246
Nurse consultant – history and
development, 246
Conclusion, 247
References, 248
16 Teamwork in Community Nursing, 253
Introduction, 253
Potential team members in community
services, 253
The continuing need for effective
teamwork, 254
The nature of teams, 256
Teams do not work effectively
when…, 257
Teams work well when…, 260
Conclusion, 262
References, 263
17 Measuring Effectiveness in
Community Health Care Nursing
and Specialist Community Public
Health Nursing, 265
Introduction, 265
The measurement of effectiveness in
the NHS, 265
Clinical governance, 266
Measuring health gain, 266
Development of research governance, 267
Clinical governance in primary care, 268
Approaches to clinical effectiveness
and outcome measurement of
health care, 270
NHS policy development and clinical
effectiveness, 273
The work of the Commission for
Health Care Audit and
Inspection, 275
Using benchmarks, 275
Measuring health gain and outcomes in
public health and primary care:
established evidence, 275
Ongoing issues for CHCNs and
SCPHNs, 277
Conclusion, 279
References, 279
18 Non-Medical Prescribing, 284
Introduction, 284
Medicines management: prescription,
supply and administration of
medicines, 284
History and background of non-medical
prescribing, 285
Education and training, 287
Maintaining competence in practice
and CPD, 290
Professional and legal accountability, 291
Current practices in nurse
prescribing, 292
Conclusion, 293
References, 294
19 Public Health Nursing – Strategic
Directions for Future Development, 296
Introduction, 296
Public health policy context, 296
UK-wide policy issues, 297
Vision for health reform, 298
The development of public health
nursing, 298
Specialist community public health
nursing, 299
Modernising nursing careers, 300
Title versus function, 301
Facing the future: a review of the role
and function of health visiting, 301
Workforce implications, 302
Public health nurses or public health
practitioners?, 303
Future development and challenges
for practice, 304
Public health priorities, 304
Children’s policy context, 305
Embracing the challenge of change, 306
Future directions, 307
Conclusion, 308
References, 308
20 Modernisation of Primary Care:
Innovation, Leadership and Enterprise
Within the Workforce, 311
Introduction, 311
What this chapter provides, 312
Commissioning, 313
Delivering a fair, personalised, effective
and safe NHS, 321
Innovation in commissioning, 322
Healthcare for London: A Framework for
Action (incorporating the principles
of world-class commissioning), 323
Practice-based commissioning, 324
Understanding the relationship
between commissioning vision
and world-class commissioning
and practice-based
commissioning, 327
Service providers, 327
Social enterprise and third sector
providers, 330
Primary care responding to the
modernisation agenda, 331
Leadership, 333
Conclusion, 335
References, 336
21 Inter-Professional Practice Teaching and
Learning, 338
Introduction, 338
NMC standards to support learning and
assessment in practice, 339
Putting the standards into practice, 340
Mentorship in community practice, 341
Preparation of practice teachers, 342
Learning, teaching and assessment in
practice, 343
Tools for assessment of profi ciency in
practice, 347
Conclusion, 350
References, 350
22 User Involvement: The Involved and
Involving Community Health Care
Nurse, 352
Introduction and overview, 352
The modern ‘PPI’ system, 353
The new lexicon: the structural
challenge of roles, skills and
responsibilities, 356
A patient’s perspective: developing a
holistic approach, 357
Stepping out and up: ‘patients’
no more, 360
Conclusion: co-creating health care
improvement, 362
References, 363
Index, 365