Health visiting: a withering profession?

Over the past 2 years, community nursing appears to have been quietly marginalized within successive government health documents. The health visiting profession in particular looks to be under the greatest threat, and it is to that issue that the discussion will be addressed. The argument will be made that changing the content of health visiting practice in an attempt to solve the apparent problems, is not sufficient in itself to both protect and allow development of the profession for the 21st century. It is of more relevance to determine the direction for health visitors within the rapidly changing context of primary health care provision. The potentially worrying changes in the community health agenda for health visitors will be demonstrated by some analysis of the Cumberlege Report 1986, the 1987 White Paper Promoting Better Health, the Griffiths Report on Community Care 1988, and the NHS Review 1989 Working for Patients. Potential avenues for action are explored, including neighbourhood nursing, and a serious attempt at membership of primary health care teams within general practice. The conclusion is that health visitors need to indulge in some painful decision-making, in order to prevent the withering away of their profession within the newly emerging context for primary health care delivery.