Kathy Kenmuir, Professional Nurse Adviser for Primary Care, Scottish Government, has significant experience in primary care and a particular expertise in public health. She writes here as a QNIS Fellow, and her views are her own.
We are working in an environment where clinical acumen has kudos, and we have created structures, resources and care around people with ill health needs to the detriment of prevention and proactive intervention. Nursing has always and will always respond to need, it will add value and it will respect the system which, in this current environment, is driven by ill health.
We provide the timely care that is needed but how do we stop the flood that is overwhelming the systems in which we work? Can we still be valued if we stop counting productivity through care transactions or work in a different non medicalised way?
My response to that question is yes – I see those who work tirelessly in primary and community care as the submariner service of our force, as cited by Victor Montori, they do not only look at the biology, but they look at the biography of the person. The relationships they build and an “every encounter matters” approach are key to ensuring that prevention opportunities are not overlooked. Primary care and community nurses work in innovative “more than medicine ways”, they are conduits that provide immense opportunity and support activation of agency. They focus on good conversations which have moved away from fixer to facilitator, making every encounter matter in the hardest of times. They provide continuity of care which is a strong enabler to support behavioural change as well as being a trusted voice.
As community and primary care nurses your leadership has never been more important.
We have the tools and I have seen innovation and transformation in many areas – vaccination and the work in NHS Grampian where the team have taken an every encounter maters approach to ensuring everyone that attends for a vaccination is offered an opportunity to talk about what is important to them with strong links back into community supporting an asset-based approach.
Many practitioners are now having different conversations using contemporary models such as group consultations – these facilitated group clinical appointments provide longer clinical appointments but more importantly enable peer interaction and support. The evidence is strong and the outcomes from this approach are producing phenomenal results in long term condition management and women’s health. People are more likely to adopt new behaviours, more likely to connect with local assets and more likely to self-manage/self-care. Whilst providing impressive efficiency (of up to 600%) and effectiveness (97% people found significant benefit) for care delivery, practitioners say that it creates job satisfaction and joy at work.
The challenge we have to do this is creating capacity within currently very stretched services. So what can we stop doing that has limited value to instate new ways of working which clearly have added value?
As community and primary care nurses your leadership has never been more important. This way of working is providing care with added value and it respects and endorses the principles of person centred approaches.
We have the tools to do different …
