Opinion  

But beneath the specifics lie some key themes that make this a genuinely exciting strategy. Innovation, development, integration, partnership and enterprise are oft-heard buzz words. But this report makes you believe they could translate into everyday practice.

Innovation and development includes PCTs commissioning for wellbeing and prevention and includes funding for local prizes and awards for innovation.

Integration has been the holy grail in primary care: no-one with a realistic grasp of primary and community care would claim that all GP teams are properly integrated with PCT-provided services, nor with district-wide and multi-professional services. But the thought of testing better ways of achieving this must excite many nurses who battle daily with the barriers between them. 'Integrated care organisations', new community trusts, 'one-stop-shops' or partnerships with charities, provide options for exploration.

And finally, the much-derided and suspected social enterprise is back on the agenda. Two things make it different this time: the right for community nurses to request to form one; and the right to take their NHS pension with them if they do. Such bold moves will still not be right for many nurses; but significant obstacles have been removed for those who want to try this model.

Alongside these options and freedoms come sharper-edged tools: 'metrics' to measure the quality of community nursing services; and 'currencies' to measure 'clinical productivity'. A new national structure will try to link up work force plans with labour market intelligence and the advice of profession-specific boards. This combination of a national framework for the big endeavours of education and planning, and local freedoms to provide the care that people need, is a balance many have tried to deliver before. Maybe this time is the right time for it to work.

- Rosemary Cook, director, Queen's Nursing Institute.