RCN policy adviser, Rachel Cackett, warns against overlooking the crucial role of nursing in primary care as Scotland seeks to shift the balance of care from hospitals to communities.

A flagship policy of the current SNP government, there are few voices that cry out against the integration of health and social care, but a growing number are raising concerns that it is simply happening too slowly.

Influential policymakers and stakeholders gather tomorrow to discuss the pace, and nature of change, happening across Scotland at the next steps for integration seminar.

Rachel Cackett, policy adviser at the Royal College of Nursing (RCN) Scotland, will be addressing attendees on the subject of supporting the integration of services, in particular, the need for effective governance, achieving value for money, and engaging patients and communities.

Tomorrow’s seminar comes days after a major report from the national public spending watchdog, Audit Scotland, said the Scottish Government was likely to miss its target to boost GP numbers by 800, adding a ‘data gap’ was making it harder to plan what primary care staff are needed when and where.

Despite highlighting a recruitment target that government characterised as integral to sustaining services will likely be missed and was predicated on no ‘reliable basis’, the report was a “missed opportunity” itself according to Ms Cackett.

“The Audit Scotland report did a very good job of highlighting the concerns particularly of our GP colleagues, but the primary care team is much, much wider than the people employed by general practice”, she explains.

“The aspiration is to have teams that work right across the community and that would include district nurses, school nurses, practice nurses and others.

“The heart of my speech on Tuesday is going to be that people have a right to the right member of staff with the right skills at the right time and in the right place, and I don’t think we are doing that enough.”

Ms Cackett highlights the crucial role of district nurses in having skills and decision-making powers that can reduce unnecessary hospital stays and admissions, but points out the vacancy rate for district nursing is currently 6.6% - rising to 8.3% for band six nurses.

She says the government had committed to outlining growth models for the district nursing workforce by September last year.

“The work went ahead – but nothing has been published to support the growth of the district nursing workforce,” she says. “And that’s within the scope of what they are doing now, that’s not talking about moving to 24/7 services for example.

“Within that growth model what we are saying is you need to make sure your decision making levels, so those qualified district nurses, are there to be able to make the decisions on their own with a person needing care about what the best course of action is, particularly if they are deteriorating.

“I think too often those specialist skills of nurses, particularly district nurses, have not been properly prioritised.

“That’s why we are really disappointed that not only did Audit Scotland not pick that up in their report on primary care, but we are also a year on waiting for the announcement from government on what that growth model for district nursing would look like.”

The integration of services began in 2011 with the aim of tackling segmented and detached methods of delivering and configuring services.

And while some areas of health and social care still default to those ‘traditional’, separate ways of working, Ms Cackett raises the work of the primary care clinical professional group (PCCPG) as strong evidence of progress.

“Set up in 2016, the PCCPG is a collaborative group of all the main clinical professions representing around 60,000 staff in Scotland, from dentistry, optometry and nursing, to allied health professionals, pharmacy and others, who are sitting around tables and making sure that, at a leadership level, they are demonstrating very clearly that we are able to work together to a common cause.”

All of the organisations involved in the group have agreed upon a document of 21 principles related to the delivery of primary care, designed to guide decision makers, who would need to provide solid justification for deviating away from those principles that have been agreed upon by so many different specialties.

Ms Cackett explained that “when we [the group] really talked about forming a distinct professional point of view on what the issues affecting our members were – they were really not that different: pressures on staff, dealing with changing demand and so on.

“We are really clear in that we know there is a need for change in primary care for example, with most of that falling within the remit of integration, and we are not the barrier: so long as there is a really good justification for what that change looks like and fits to the principles we have set out.”

A key area of work for RCN Scotland recently has been its leadership programme for nurses who took on representative roles within Integration Joint Boards (IJBs) – positions “quite different to the roles they have ever held before”, Ms Cackett says.

She says having a nurse on the IJBs is essential to enable them to give advice on decisions around how primary care teams are designed, adding their voices “have to be listened to and acted upon”.

“Part of what I will be talking about on Tuesday is about how you need decision making at the front line, so you need the right numbers of staff, but you also need decision making at a commissioning level as well – at a design level.

“And you need nurse clinical decision making there to know what those teams should look like in order to be able to give people the sorts of wraparound services they should have.”