Independent Nurse: Primary care nurses feel let down by Agenda for Change.(survey of nurse practitioners )

More than one in 10 nurse practitioners and specialist nurses have seen their pay drop after transferring to Agenda for Change (AfC), according to an Independent Nurse survey.

The survey included 335 primary care and community nurses, of whom 139 reported they were paid under AfC. It showed 13 per cent of nurse practitioners' pay and 17 per cent of specialist nurses' pay had decreased.

The survey showed deep unhappiness with the new pay system. Half of all nurses paid under AfC felt it was 'a bad thing', contrasting with 28 per cent of those nurses not paid under AfC.

Less than half of all nurses agreed AfC provided a structured career path (42 per cent) and that learning was appropriately rewarded (17 per cent). The majority of nurse practitioners, specialist nurses and district nurses did not feel AfC rewarded them for taking on advanced clinical roles.

Although 82 per cent of practice nurses thought GPs should implement the new system, 90 per cent are currently not paid under it.

Sue Nutbrown, chair of the Practice Nurse Association, said: 'I have to say that I've changed my thoughts about AfC in the last 18 months after I've seen it in practice and it just isn't working as well as it was hoped.'

She said she was beginning to think the RCN would do more good by offering courses and support for primary care nurses to negotiate their own pay locally.

However, Gerry O'Dwyer, RCN employment relations adviser, said that AfC was still in its early stages and pointed out that half of the survey respondents transferred to AfC had seen their pay increase (49 per cent).

'Once the job evaluation system and the Knowledge and Skills Framework are fully implemented, the system will really deliver on new and career enhancing roles,' he said.

judy.sands@haynet.com

- Further survey results page 8; Opinion, page 12. *****************************************************************

Less than 20 per cent of practice nurses, nurse practitioners and specialist nurses received a pay rise after qualifying as an independent prescriber, a survey by Independent Nurse shows.

Out of a total of 335 nurses who responded, 194 confirmed they were qualified prescribers. Of those 26 were practice nurses, 82 were nurse practitioners and 29 were specialist nurses. A massive 79.5 per cent reported they had not had a pay rise after completing the 26 day course allowing them to independently prescribe.

Barbara Stuttle, chair of the Association for Nurse Prescribing, said she was disappointed with the results.

'I'm not saying that just because a nurse takes a prescribing course they should get an automatic pay rise but if they're prescribing they should also be diagnosing and nurses need to be rewarded for the increased risk they are taking on.'

Matt Griffiths, RCN nurse prescribing adviser, said he had raised the issue with the college repeatedly but it had said prescribing was considered in Agenda for Change bandings associated with advanced nursing practice.

'I'm not surprised by these results because I didn't get a pay rise when I qualified as a prescriber either. But I think it will come as more and more jobs are advertised demanding nurses who are able to prescribe and offering higher salaries to go with it.'

Ms Stuttle said nurses had to realise the advantages they brought to a job when they were active prescribers.

'We need to start learning some lessons from the medical profession. GPs would never accept such an increase in risk and responsibility without an increase in pay. Nurses and our representative bodies need to become much better at articulating what it is that we do,' she said. *****************************************************************

Nurses and other health professionals must be involved in practice-based commissioning (PBC) to ensure transparency in the process, according to government guidance.

PCTs should also ensure GPs have incentives to involve other professionals and ensure that nurses are given appropriate training in commissioning, budgets and strategic thinking, it states.

The guidance is part of a series of bulletins on PBC produced by Primary Care Contracting, formerly part of the Modernisation Agency.

'Incorporating other professionals within the structures can bring not only a breadth of knowledge and perspectives but also introduce greater transparency to balance out any undue influence from a single interest group,' it explains.

'Many of these clinicians are being given prescribing rights including supplementary and, for some, independent prescribing. This creates a direct link with PBC budgets.'

However, it says a recent survey revealed 'only limited' involvement of other health professionals, despite a target for universal PBC to be in place at the end of this year. The guidance warns that community nursing teams may be worried about their futures and will be disinclined to take on extra responsibilities.

Despite this, all efforts should be made to involve them and nurses should be given information about PBC, the rules, who to contact and data on referrals, admissions and prescribing in the area.

It says nurses could have a role to play in holding indicative budgets for registered patients, supporting and overseeing commissioning decisions and being micro-commissioners, particularly in regard to long-term care, end of life care and public health.

Practices should begin identifying where the role and actions of nurses, such as prescribing and referral management, have an immediate effect on the PBC budget.

The guidance also urges practices to consider nurse practitioners, practitioners with a special interest, community matrons, health visitors and district nurses as possible solutions to PBC problems and shifting services out of hospitals.

- What do you think? Email your views to independentnurse@haynet.com. *****************************************************************

Nurses are likely to be targeted in the recruitment drive for medical care practitioners (MCPs), the DoH's primary care czar has indicated.

Dr David Colin-Thome told Independent Nurse that the new role 'offers a real opportunity for those nurses who want a change in career direction, as they will be well placed to apply'.

However, Benny Harston, chair of the RCN's Nurse Practitioner Association, said the original stated intention was to attract people who would not have previously considered an NHS career, such as life science graduates.

'The problem with this is that it does not solve workforce capacity problems. There is no point targeting an already depleted nursing workforce to boost another workforce. Who will do the nursing?'

The government has just finished consulting on new competencies for MCPs, which are based on physician assistants in the US.

- Opinion, page 15. *****************************************************************

The government is planning to announce a new national service framework (NSF) for COPD.

A spokesman said he was unable to reveal details as yet, but confirmed the NSF would be published in the summer.

It follows a recommendation for the NSF in the chief medical officer's report last year and figures earlier this year showing COPD patients topped emergency admissions in 2003/04.

It also coincides with recommendations on treatment of COPD exacerbations from an international taskforce of respiratory experts to be published this month in the Primary Care Respiratory Journal.

The taskforce is calling for greater awareness that many COPD exacerbations are preventable, increased patient knowledge and clearer explanations of exacerbations, as well as development of treatment pathways and model programmes for multidisciplinary care.

It also recommends greater use of spirometry in smokers, patients with suspected COPD and in those with a history of frequent exacerbations. *****************************************************************

Asthma UK has issued a warning that attacks may occur during thunderstorms. It is believed that the inversion of temperatures bring down pollen granules which the moisture then breaks up to a size that can be inhaled in large quantities. In June last year there was a six-fold increase in emergency asthma admissions on one weekend of thunderstorms. *****************************************************************

A national survey of 5,600 carers has found more than three-quarters have had their health affected by caring. Stress, depression and backache were the most common complaints. However, only one in four had been offered a health check by their GP or practice nurse. Charities are calling on PCTs …