Opinion  

Pilots to test the new model, which will see a generic community nurse role replace district nurses, health visitors, school nurses and family health nurses, will run over two years in four areas.

The government says nurses were involved in developing the model, but health visitors in particular dispute this. A survey of more than 300 Amicus/CPHVA members last year showed that 72 per cent felt their views had been completely ignored.

Scotland is clearly keen to go its own way on health, but this plan has implications for nurses across the UK and longer-term recruitment plans. Would a Scottish 'community nurse' be able to move into a district nurse role in Cardiff, for example? Could a school nurse from Cumbria take up a post in Lothian? Would she want to if it meant taking on a generic role? What about the future of district nurse and health visiting education in Scotland?

Ministers say they are 'keeping an open mind' and will not make a decision about the future of community nursing until the pilots' results are known. However, many nurses are worried that once change starts there will be no going back. Much organisational change will be needed to develop the generic role. It is hard to see how the pilot boards could revert back to the current model without a great deal of upheaval and significant costs.

Perhaps most worrying is that these pilots are happening without the support of front-line staff. Nurses dislike the idea and doctors object. Without the buy-in of these groups there is every possibility that the initiative could fail before it gets out of the blocks. Indeed the CPHVA study suggested that nurses were more likely to quit the profession if change is forced through. It would be a bitter irony if ministers' plans to secure the long-term future of community nursing resulted in a staffing crisis.

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