Developing Community Nursing Practice

John Unsworth

The UK National Health Service, in common with most other public services, has undergone a period of considerable change and restructuring since the mid-1970s. It is fair to assume that these changes in policy and structure will continue in the future, as the NHS struggles to cope with rising demands and finite resources. At the same time, both the health professions and the practitioners themselves have had to become increasingly adept at coping with and meeting the challenges and opportunities presented by change. Within the NHS primary care was one area that saw the greatest stability through the 1970s and early 80s. Indeed many people perceived primary care as a sacred cow that should remain untouched. However, at the same time, people viewed primary care as a highly effective way of providing health care to large numbers of people at relatively low cost. All of this was to change when the Conservative government announced the most far reaching reforms ever to impact on the NHS (DoH 1989). These reforms were not only to change the way services were provided, but also were to reshape the way practitioners worked forever. These changes introduced a quasimarket with the creation of a purchaser-provider split, general practice fund holding and new self-governing hospital and community trusts. In many cases, practitioners were freed from the constraints of management and were encouraged, indeed expected, to develop practice. Some practitioners were well placed to meet these challenges and drive practice forward, while others were anxious and concerned about change. The latter response is understandable, when we consider that some community nurses experienced threats to their continued employment as general practice fundholders, exasperated by management, and sometimes

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