Professional costs and invisible value in the community nursing market

Abstract

This paper considers the consequences for community nurses of the introduction into the National Health Service (NHS) of the internal market and the purchase of community health services by fundholding general practitioners (GPs). We explore the effect of the workings and culture of the market on the interprofessional relationship between GPs and community nurses and on community nurses' practice and intraprofessional relationships with nurse colleagues. Drawing on the literature and research data from a study in two health districts in North West England, the paper first describes new pressures and demands upon community nurses as a result of the contestability of contracts and the purchasing role of fundholding GPs. It then goes on to describe how, whilst generating new stresses, those very service changes arising from the market are eroding or abolishing established professional networks among community nurses, which they described as a major source of support. The paper concludes that, with the purposeful shift towards a Primary Care-led NHS, in which more GPs will have a wider involvement in purchasing, new mechanisms to support community nurses will be crucial.

Key Words:

• Healthcare market
• primary care
• interprofessional relations
• intraprofessional differentiation