Investigating the nursing contribution to commissioning in primary health-care

This study set out to investigate nurses', doctors' and managers' perceptions of the nursing contribution to commissioning in primary health-care.

The study was undertaken in the light of the proposal in the government's White Paper The new NHS, Modern, Dependable that community nurses should play a lead role in commissioning health services as members of the new primary care groups.

Semistructured taped interviews were conducted, with seven community nurses, two community midwives, seven managers and four general practitioners, covering three geographical locations in the UK. The data were transcribed and analysed using a template approach, where text is analysed through the use of an analysis guide, or codebook, consisting of categories, or themes, relevant to the research questions.

The main themes to emerge were that nurses had an important contribution to make to commissioning on the basis of their clinical knowledge, their awareness of health need and their knowledge of health promotion. Additionally, the ability of nurses to negotiate at different levels across professional groups and with the public was perceived as an important skill in a commissioning role. However, findings also indicated that nurses need additional knowledge and skills if they are to perform their role effectively. Being sidelined from the commissioning arena, poor interprofessional collaboration and the potential for resistance from some general practitioners and managers were identified as constraints on the nursing contribution to commissioning. Combining clinical caseloads with commissioning responsibilities and a lack of support systems for nurses in commissioning were also identified as constraints.

Nurses' commissioning-related knowledge and skills will have to be developed and constraints on the commissioning role of nurses challenged if the perspectives and values of nursing are to help to reshape our healthcare system.