Primary Health Care Research and Development 2003; 4: 57–68
Partnerships for health: expanding the public
health nursing role within PCTs
Robert McMurray and Francine Cheater School of Healthcare studies, University of Leeds, 24 Hyde Terrace, Leeds,
UK
Since 1997, Labour Governments have championed partnership working as part of a
commitment to develop a new public health agenda. Multidisciplinary and multi-
agency working have been placed at the heart of attempts to tackle widening health
inequalities, with Primary Care Trusts (PCT) being placed at the forefront of a corpor-
ate approach to delivering improvements in individual, community and population
well-being. However, observed practice in relation to public health collaboration has
rarely met the challenge of past policy prescriptions. Furthermore, we have limited
understanding of who is best placed to meet the challenge of securing public health
partnerships within a primary care led National Health Service (NHS). This paper
reviews the need for PCT involvement in partnership working, assesses the potential
contribution primary care nurses can make to the co-ordinated delivery of the new
public health agenda, and identies key issues for policy and practice. It concludes
that nurses have the opportunity to play a key role in the development of partnerships
for improved public health at the PCT level. However, it also notes that the develop-
ment of such functions will require an expansion of existing nursing roles, a willing-
ness to take on a more overtly political role, and a deeper consideration of the con-
stituents of successful collaborative action for improved public health.
Key words: nursing partnership; collaboration; primary care; public health
Introduction ing at the level of both organizations and pro-
fessions has been poor (Rowe et al., 1998; Baileff,
It is widely recognized that for government to 2000; Plews et al., 2000). There has been little
deliver improved public health the support of key agreement or understanding on the denition or
stakeholders is required (Glendinning, 1999). Fur- scope of public health (Pearson et al., 2000; Plews
thermore, their commitment to collaboration is et al., 2000; Rowe et al., 1998). The development
imperative (Baileff, 2000; DoH, 1999; DoH, 2001; of population based public health has been hin-
Gerrish, 1999; Glendinning, 1999; Plews et al., dered by the paucity of research evidence on which
2000). Indeed, ‘collaborative working for health to base practice (Baileff, 2000; Gerrish, 1999;
and social well-being’ has recently been identied Pearson et al., 2000; Plews et al., 2000). Cultural
as a key competency area for those working in a divides, enduring communication problems, poor
public health capacity (Health Works, 2001). co-ordination and inadequate planning both within
Historically, however, diverse agencies and pro- NHS organisations, and between the NHS and
fessions have failed to form the sustainable work- other agencies, has hindered attempts to develop a
ing partnerships required to deliver improved community level focus (Glendinning, 1999).
population health. Numerous reasons for this fail- Finally, the dominance of the bio-medical model
ure have been identied. Joint and joined-up work- within public health medicine (Pearson et al.,
2000; Plews et al., 2000), combined with the nar-
row disease and individual patient focus of many
Address for correspondence: Dr Robert McMurray, School of
medical practitioners within primary care (Pearson
Healthcare studies, University of Leeds, 22 Hyde Terrace, et al., 2000), has led to the marginalization of other
Leeds LS2 9LN, Email: r.m.mcmurray@leeds.ac.uk professions, agencies and approaches within the
ÓArnold
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, 58 Robert McMurray and Francine Cheater
wider public health arena (Gerrish, 1999; Rowe are charged with ‘improving the health of their
et al., 1998). populations through activities that reach beyond
In response to these shortcomings policy the NHS’ (Gillam et al., 2001:89) securing
documents such as Saving Lives and Making a Dif- improvements in health and reducing inequalities.
ference have suggested that attention to public Indeed, it is in the reduction of inequalities that the
health be refocused and the role of other nonmedi- public health role of PCTs and primary care nurses
cal professions expanded (DoH, 1999; DoH, can be most clearly discerned.
1999b). Specically, it has been suggested that the Public health is concerned with more than the
potential that exists within other professions, such absence of disease and the provision of medical
as nursing, to deliver a more holistic, multidiscipli- care. It is premised on recognition of the associ-
nary and population centred public health should ation between low educational achievement, unem-
be developed. This paper explores that potential ployment, poverty, lifestyles and health inequality
with specic reference to primary care and com- (Acheson, 1998; DoH 1999b). Furthermore, socio-
munity health care nursing. In particular, it con- economic explanations of inequality broadly dene
siders how an expanded nursing role relates to the public health activity as the organized efforts of
new public health agenda; it reviews how nurses society to prevent disease, prolong life and pro-
can contribute to the development of partnership mote health and well-being (Acheson, 1998). It is
working for improved public health, including a in this context of changing systems, new organiza-
description of the antecedents of successful part- tional priorities, an emphasis on the reduction of
nership working; and identies key issues for pol- inequalities, promoting improved health and the
icy and practice. desire to develop ‘integrated care’ which is ‘based
on partnership and driven by performance’ (DoH,
1997: para 2.2), that the role of primary and
Policy Context
community care nurses (including health visitors,
midwives and nurses) is being dened. It suggests
The NHS Plan (2000) sets an agenda for far- an inclusive denition of public health nursing
reaching change across the NHS in the UK. It
operating at different levels. These range from
aspires to a system designed around the patient,
working with individuals at one extreme (e.g.,
delivering improvements in health, while securing
immunisation, providing one-to-one health pro-
levels of service that patients expect and NHS staff
motion advice) to leading programmes at a com-
want to provide. It heralds a radical redesign of the
whole care system (DoH, 2000: 7.3) with a munity level at the other (e.g., health needs assess-
requirement for change at every level of the NHS ment, developing and implementing health
(DoH, 2000: 16.10). improvement programmes and commissioning ser-
At the centre of these changes in England are vices within a PCT locality). Between these
PCTs. Free-standing, legally established, statutory extremes public health nursing may target families
NHS bodies, PCTs are responsible for planning (e.g., developing parenting skills and managing
commissioning and delivering health services to children with behavioural difculties), groups (e.g.,
local communities. Accountable to strategic health smoking cessation and school health) or communi-
authorities, they offer local stakeholders including ties through community development work (e.g.,
general practitioners, nurses, therapists and man- working with disadvantaged communities such as
agers the chance to make decisions about the pro- homeless people to improve health and reduce
vision of care close to the point of delivery. social exclusion). As such, public health nursing
PCTs are not, however, to work in isolation. can be dened as a complex endeavour intended
Documents such as the NHS Plan recognize that to tackle inequality and promote community health
if the health of the nation is to be improved, PCT and well-being through interventions tailored to the
members will have to work collaboratively with needs of individuals, groups, populations and pol-
local authorities, voluntary agencies and communi- icy communities. It is with this denition in mind
ties if people are not to fall in the cracks between that the paper explores the potential role of primary
services (DoH, 2000: Executive Summary). and community health nurses in delivering the pub-
Accordingly, as part of their core functions PCTs lic health functions of PCTs.
Primaryfrom
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