As a group, we nurses are not really all that good at getting involved in the politics of the organisations who employ us, or of the National Health Service as a whole. We are good at moaning that things are not as they should be, that managers don’t understand the challenges of caring for our patients and that change is done for change sake. But very few people get involved in making sure their voice is heard. That goes for others working in the NHS, probably the most vocal and those who get their voice heard most are the British Medical Association. In the last few days the BMA have began to mobilise against the proposed changes to primary care and the commissioning process. Quite rightly they identify that this feels like the end of the NHS as we know it, they worry about the future of hospitals and the jobs of doctors; well they would wouldn’t the? My question is where is the voice of nursing in this? The Royal College of Nursing has remained silent. If they have nothing to say, then what is the individual nurse to think?

The main change which is going to happen, is that the commissioning arm of the Primary Care Trusts (PCT) will strengthen as will this aspect of the work of GP practices which have combined into super practices. But what is called the provider arm (nurses and therapists to you and me) will need to be delivered by which ever group can provide the best patient pathways for local people. Well this is the gist of it. The providers could be the PCT itself, but kind of a provider arm, it could be the private sector for example a hospice providing care to people who are terminally ill, or it could be a private organisation. Who is to stop a large private health care (or other) organisation setting themselves up to provide the care out there in the community or in the surgicentres and then employing the nurses currently working for the PCT. Who employs those individuals? Do they still work for the NHS and is it NHS care which is being provided. The media focuses on people needing an operation and quite rightly on how long the wait for that operation might be. However what they fail to recognise is that this particular initiative is about people with conditions which cannot be cured by an operation as such, and may suffer from several conditions at that. This care is labour intensive and expensive and long term; is this the area private industry will want to be involved with?

In a speech last week, Patricia Hewitt the Health Secretary, said that she does not like change for changes sake. Well Patricia, where I am sitting this feels like just such a thing. I am not denying that changes to services are needed. There is far too much custom and practice going on, people doing a job in a way that has always (or for a long time) been done that way. But do we need to go through another expensive process of complete change?

I know of people in fellow organisations who are seriously looking at their career options. Thinking that perhaps obtaining a law degree would be an option. After all the law is less likely to change than the fast revolving NHS. Personally I quite like change, it keeps you on your toes, but this is down right scary.