Chief Nursing Officers 10 key roles for nurses DH 2000

• to order diagnostic investigations such as pathology tests and X-rays

• to make and receive referrals direct, say, to a therapist or a pain consultant

• to admit and discharge patients for specified conditions and within agreed protocols

• to manage patient caseloads, say for diabetes or rheumatology

• to run clinics, say, for ophthalmology or dermatology

• to prescribe medicines and treatments

• to carry out a wide range of resuscitation procedures, including defibrillation

• to perform minor surgery and outpatient procedures

• to triage patients using the latest IT to the most appropriate health professional

• to take a lead in the way local health services are organised and in the way that they are run pregnancies, as well as a doubling in GUM clinic attendances in England over the preceding ten years. The strategy was produced as part of a nationwide programme of investment and reform, to modernise services around the needs of patients and service users. It aimed to tackle inequalities in service provision and ensure that the NHS works to prevent ill health. It was drawn up in line with the principles of The NHS Plan (DH, 2000) (see above), and by involving service users and experts from across the country allowed clients to have a real say. Unlike The Health of The Nation (1993), which had to be achieved within existing budgets, the strategy was accompanied by extra investment of £47.5 million over a two-year period.

The strategy hoped to reach its aims (see Box Two) by delivering evidence-based effective local HIV/STI programmes so that people could make informed decisions about preventing STIs, including HIV, and by setting a target to reduce the number of newly acquired HIV infections. It also hoped to increase the offer and uptake of HIV testing to reduce the number of undi-agnosed people with HIV in the UK, as well as increasing the offer and uptake of hepatitis B vaccine, both of which policies came with specific targets.

It highlights collaborative working between providers so that they deliver a more comprehensive sexual health service to patients and sees a broader role for those working in primary-care settings. The strategy also sets out a new way of working in which there will be three levels of service provision (see Table 1). The strategy acknowledges that for good practice level one service should be universally provided in General Practice, but that level two will also be provided by some general practitioners that have a 'special interest' in sexual health as well as in family planning clinics. Departments of sexual and reproductive health and HIV will provide the specialist level three services.

This comes at a time when GPs are over-stretched, and with practice nurses and primary-care nurse practitioners already providing contraceptive care (LSC, 2002) it is natural to assume that their roles will be expanded to incorporate these recommendations. It has been suggested that nurses working in primary care already provide advice and health promotion around sexual health issues (LSC, 2002). Alternatively, GP practices may employ sexual health nurse practitioners to undertake clinical sessions for them.

Box Two

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