Organizing community nursing: an exploratory study.
The NHS in the 1990s places increasing emphasis on primary care and puts pressure on general practitioners (GPs) and community nurses to deliver a broad range of high quality care in the most cost-effective possible way. In attempting to achieve these objectives, the British National Health Service (NHS) and its individual health authorities have re-examined the available range of organizational choices and increasingly the tendency is to organize community nursing around the focal point of general practice. The authors' evaluation of six innovative 'pilot projects' showed the effects of different organizational choices with respect to basing, purchasing, provision and management of community nursing services. It was found that there are some advantages to focusing primary care on the GP; basing of nurses on the practice is particularly advantageous. There are, however, some very clear indications that the adoption by GPs of multiple, and sometimes conflicting, roles of manager, provider and purchaser of community nursing inhibits the development of fully integrated primary health care teams and can be detrimental to the nursing function. It is concluded that the NHS needs to explore other less GP-centred organizational configurations within primary care.
Tinsley
R.
R
Aston Business School, Aston University, Birmingham, UK.
Luck
M.
M