Are senior nurses on Clinical Commissioning Groups in England inadvertently supporting the devaluation of their profession?: A critical integrative review of the literature

Abstract

This paper discusses the role of senior nurses who sit on clinical commissioning groups that now plan and procure most health services in England. These nurses are expected to bring a nursing view to all aspects of clinical commissioning group business (National Health Service England 2014a; Olphert 2014). The role is a senior level appointment and requires experience of strategic commissioning. However little is known about how nurses function in these roles. Following Barrientos' methodology (1998), published policy and literature were analysed to investigate these roles and NHS England's claim that nursing can influence and advance a nursing perspective in clinical commissioning groups. Drawing on work by Berg et al (2008Berg et al ( , 2014 on 'new public management' we discuss how nurses on clinical commissioning groups work at the alignment of the interests of biomedicine and managerialism. We propose that the way this nursing role is being implemented might paradoxically offer further evidence of the devaluing of nursing (Latimer 2014) rather than the emergence of a strong professional nursing voice at the level of strategic commissioning.

Do governing body and CSU nurses on clinical commissioning groups really lead a nursing agenda? Findings from a 2015 Survey of the Commissioning Nurse Leaders' Network Membership

“…Secondly, it has been asserted that a key advantage of the CCG 'model' over other forms of commissioning is that it places the clinician at the forefront of commissioning decisions but there is very little evidence for this claim. Allan et al (2016b) argue that this claim conflates clinician and patient voices and the result of this conflation is that nursing (including GBNs themselves and nursing leaders in NHS England) may sometimes appear to uncritically accept CCGs and the unchecked growth of new public management. The GBNs and senior nurses within CSUs are motivated to ensure a nursing dimension in CCG decision-making and to advocate for patient interests and they may well be correct about the influence or impact that they have in relation to CCGs, but obviously this cannot be determined solely through survey research based on their own perceptions, and in any case the relative immaturity of CCGs would make it difficult to assess, through any methodology, the extent and nature of any impact that nurses may be having on CCGs.…”

“…) and a pilot study (Allan et al . ) of a sample of CNLN members distributed by NHS England. The pilot survey was short and exploratory in nature, with many open‐ended questions, as little was then known about the experiences of nurses in CCGs.…”

“…There is relatively little research published on GBN roles (Trevithick ; Allan et al . ,b). Recently, the NHSCC () published findings from a membership survey ( n = 41), and found that:

‘There are now two distinct groups of nurses; those who act as the registered independent nurse on the CCG governing body, and executive nurses who are fully embedded in the daily CCG activity with specific responsibilities.

…”

Compassion in practice—Evaluating the awareness, involvement and perceived impact of a national nursing and midwifery strategy amongst healthcare professionals in NHS Trusts in England

“…The global economic crisis triggered the acceleration of “managerialist” systems into public health systems globally (Allan et al, ; Rudge, ), resulting in extensive cuts to funding of public health systems. These funding cuts were framed as efficiency savings and the effective use of resources.…”

“…The global economic crisis triggered the acceleration of "managerialist" systems into public health systems globally (Allan et al, 2016a;Rudge, 2015), resulting in extensive cuts to funding of public health systems.…”