Chief Nursing Officer Bulletin

Nurses have played a key role in the drive to improve standards of hospital cleanliness and the quality of food.

No hospitals received the ‘red rating’ in this year’s hospitals standards statistics released by the Patient Environment Action Teams (PEAT). The red rating denotes standards in need of urgent improvement, for either cleanliness or food quality.

In terms of cleanliness, 687 hospitals, or 78 per cent of those assessed this summer, were classed as ‘green’, while 191 (22 per cent) were considered to have acceptable standards and were awarded an ‘amber’ rating.

The national food assessment results also showed an improvement with 43 per cent of hospitals achieving green status and none being marked as poor.

In 2002, only 17 per cent of hospitals were rated good and 15 received a red rating.

In almost 90 per cent of acute hospitals patients can now get drinks and light refreshments around the clock and two-thirds offer patients the chance for additional snacks at least twice each day.

Modern matrons have the authority to set and monitor standards of hospital cleanliness – and remedy problems if they occur. They have a central role in PEATs, both in involving patients and assessing standards.

Christine Bentley MBE has worked at the Queen Elizabeth the Queen Mother Hospital in Margate for 23 years, first as a staff nurse, then sister, rising gradually to her current position of modern matron. The hospital has achieved a green mark for cleanliness both this year and last.

She said monitoring and maintaining standards of cleanliness was an important aspect of a modern matron’s role.

"All the way through my nursing career there has been responsibility for maintaining cleanliness but now that responsibility is greater.

"In the past there were barriers which could not be overcome but the modern matron role gives us clear authority to take these issues further.

"I am able to go around the hospital and see that things are running smoothly and that acceptable standards are in place. If they are not, I have the authority to ensure those issues are addressed.

"In terms of cleanliness, it is about maintaining a high standard and ensuring those standards do not slip.

"First impressions for the patient are vitally important – they want to see a clean hospital and of course it is an important part of their health care to be looked after in the cleanest possible surroundings."

An initiative aimed at making NHS nurses and other staff aware of the opportunities for working on overseas humanitarian projects has been launched.

A toolkit – International Humanitarian and Health Work: Toolkit to Support Good Practice – shows the benefits that such work can bring to the NHS and its patients and to the professional development of staff.

It contains information and best practice advice for both individuals and employers and is designed to provide an understanding of the varied opportunities available and the skills and competencies required.

The Department of Health has produced the toolkit, the main purpose of which is to raise awareness of the issues surrounding the release of health professionals from the NHS to work abroad on humanitarian projects.

The toolkit contains good practice guidelines and resources to help those interested in getting involved in such work. It also ensures that staff understand the wide range of opportunities available to them.

The department has also published a compendium of case studies featuring NHS staff from various backgrounds either already involved with or planning such projects.

The compendium has details of more than 40 volunteer NHS teams that spend considerable time and resources developing and providing services in countries such as Russia, Ghana, Iran and China.

The Department of Health is keen to hear from people who have been involved in such projects so they can be added to the compendium.

Nurse trainer Tim Clarke visited Ethiopia in April this year as part of an institutional link organised through the Tropical Health and Education Trust (THET). THET has several links between UK and African hospitals and medical schools.

Tim, from Nevill Hall Hospital, Abergavenny, worked with nurses in Dilla Hospital and health centres on their training needs as part of a long-standing collaboration between the two hospitals.

He said: "This was a very interesting, exciting and enjoyable visit. It gave insight into an organisation that is struggling to develop medical services in a difficult environment with very limited resources.

"The people are extremely friendly and helpful and visits to individual’s homes enabled a clear view of the culture and lifestyle in Ethiopia.

"Participation in future visits should be encouraged as a developmental programme for trust staff."

A specialist nurse is spearheading a local community’s drive to help people stop smoking and prevent them starting.

Katharine Lockhart is aiming to help 500 people kick the habit this year in the Tendring area of Essex.

As Tendring PCT’s stop smoking co-ordinator specialist advisor, she is co-ordinating a strategy aimed at tackling what is a major local issue.

The trust’s population area of 134,000 includes high numbers of smokers living in deprived areas. Health organisations, schools and the local council are all involved in a campaign targeting people at both ends of the spectrum – from schoolchildren to pensioners.

So far 130 people have given up this year but Katharine – a former grade ‘G’ practice nurse – knows more work is needed if she is to achieve her target by next April.

"The message I want to get over to people is that they are not alone and help is available for them," she said.

Training sessions are held for health care workers including district nurses, practice nurses and pharmacists, with sessions taking place inside health, community and leisure centres.

"What we offer is motivational, one-to-one support for anyone who wants it – every day of the week," said Katharine.

"All the local GPs have referral forms to send patients who want to stop smoking to us.

"An 80-year-old man had been smoking since he was 13 and was on 60 a day. He took a lot of work but eventually quit in the end."

Group sessions are held at sports venues and GP surgeries, while dedicated sessions are even being held to help 20 workers at a local factory which recently introduced a no smoking policy.

Fitness consultants who have sat in on the sessions also accept GP referrals through the ‘active for life’ campaign, a scheme set up through Katharine’s team and the local council.

"We are also going into senior schools, using theatre groups and role-play sessions to try and get the message across that smoking is bad for you – it is vital to catch the young people early," said Katharine.

A high-profile publicity drive has also boosted the campaign, including health checks being carried out at local shows – including an airshow.

Katharine added: "Smoking is a big issue in Tendring and we are doing everything we can to ensure people get the help, support and education they need."

Nationally, nearly 124,000 smokers kicked the habit last year after receiving help from NHS stop smoking services, according to the latest Department of Health statistics.

Of the 234,400 smokers in England who set a quit date between April 2002 and March 2003, more than half said they had successfully given up four weeks later.

The services, set up as part of the Government’s strategy to tackle the huge toll of disease and death caused by smoking, have helped 123,900 give up – exceeding the target of 100,000.

Smokers wanting to quit can access a range of NHS services including a national telephone helpline (0800 169 0 169), nicotine replacement therapy and Zyban on prescription, one-to-one counselling and advice, and group support. Pregnant women can also access specialist services.

The Government has allocated £138 million to NHS stop smoking services to help deliver the target of 800,000 smokers giving up at week four by 2006.

A nurse who has devised a scheme to benefit people with learning disabilities and health care staff has been recognised with a national award.

Ruth Denny, a primary health care liaison nurse in learning disabilities for Wokingham PCT, is the first winner of the Foundation of Nursing Studies/National Network for Learning Disabilities Nurses Award.

Ruth’s award-winning pilot project is designed to reflect the fact that while people with learning disabilities are more likely to need primary heath care, they are less likely to seek it.

The project, which will involve three local GP practices, will ensure people with learning disabilities know how to get help and that their health needs are reviewed.

It will also help GP practice staff be aware of the fact that people with learning disabilities are in the area and may need special treatment.

The project will offer training for primary care staff – such as practice nurses – to make sure they are confident and competent when working with people with learning disabilities.

Ruth said: "This project is a pilot so in the future I'm hoping the PCT will provide funding for the health reviews to be offered to everyone with a learning disability in Wokingham.

"Obviously, the project links in very strongly with the objectives we're trying to meet for ‘Valuing People' so I'm optimistic that this funding will come through."

Debra Moore, the Department of Health’s nursing adviser for learning disabilities, said: "The National Network for Learning Disability Nurses is a good forum to help promote the implementation of 'Valuing People'. The FoNS/NNLDN Award helps nurses to share, celebrate and spread best practice arising from the exciting and challenging health and social care agenda."

The award was set up to reward learning disability nurses who are working in innovative, person-centred ways and to improve the experience of health care for service users.

It will be offered again in 2004 and more information is available by e-mailing liz.welch@fons.org

The National Patient Safety Agency (NPSA) meanwhile has appointed nurse Vicky Stobbart as its associate director with responsibility for improving safety for patients with learning disabilities.

Her programme will involve analysing data on accidents and practical observation of conditions on the frontline of services.

Vicky is experienced in learning disability issues, having been a member of the chief nursing officer’s practice advisory group.

She said: "I joined the NPSA for the opportunity to improve patient safety for a group of people who are particularly vulnerable and at risk in the health care setting.

"I am looking forward to working closely with people with learning disabilities, carers and frontline staff in shaping this new and developing agenda."

Nursing director Lesley Doherty is on a mission to help recruit hundreds of extra neonatal nurses.

She has been seconded to the Department of Health to specifically tackle shortages in nursing specialties.

Her initial work is focusing on the current issues regarding vacancies for experienced neonatal nurses and the recruitment of up to 500 extra nurses to meet the requirements of the Neonatal Expert Review Groups report.

There are currently about 8,000 neonatal nurses working in the NHS. Proposed plans to provide a further 75 neonatal cots nationwide mean additional staff will be required.

Lesley, who until April was director of nursing and quality at Burnley Health Care NHS Trust, said: "It’s not such a problem recruiting D grade nurses. But we are finding that E and F grade nurses are moving on to other work such as paediatric intensive care or the community, or they are retiring.

"I’m looking at producing a framework for neonatal nursing recruitment and retention that could then be used as a template for other specialties including cardiothoracic or renal."

It is anticipated that the extra neonatal nursing posts will continue to be filled by newly-qualified nurses, returners – particularly those who may have already returned but are currently working elsewhere – and through international recruitment.

Lesley’s framework is aimed at workforce development confederations and clinical networks, which will be urged to produce action plans for neonatal nursing recruitment and retention.

Lesley started her 12-month secondment in April. She is also overseeing the national recruitment and retention projects in primary care, nursing and midwifery.

Nurses have a crucial role to play in promoting the understanding and better use of medicines.

Ask About Medicines Week (AAMW) is a UK-wide initiative from 12-18 October that aims to help promote medicine partnerships between users, carers and health professionals by encouraging patients to talk about their medication.

By creating a better understanding of what medicines do and how to make the best use of them, patients will be more able to control their own health and health care.

On average 70 per cent of the UK population is on prescription or over-the-counter medicines at any one time (Office of Statistics, General Household Survey, 1997). Up to 50 per cent of medicines for long term conditions are not taken as prescribed, as many as one in five patients fail to collect a prescription from the pharmacy and 30-45 per cent of patients do not pick up repeat prescriptions.

Nurses often play a key role in patient medication management and can use AAMW to share their expertise.

Chief nursing officer Sarah Mullally said: "This is an opportunity to encourage patients to ask about and understand their medication by making positive use of the skills of all nurses. Nurses have a unique role in enabling patients to feel comfortable talking about their medicine taking, as well as providing access to helpful and reliable medicines information."

AAMW aims to help make asking questions about medicines become the norm, to help make more effective use of health professionals and resources and to reduce medicine waste.

Pharmacies will be distributing a prompt card with prescriptions, with tips on how patients can make the most of their discussions with health professionals and key questions to ask about medicines.

AAMW themes include babies and children, women’s health, people with mental health problems, men’s health, older people and medicines and people living with chronic illnesses.

This month the chief nursing officer Sarah Mullally discusses how nursing roles in the acute and primary care sectors can complement each other.

If you are a nurse on a busy acute ward you might be forgiven for thinking that what happens to nursing in the community and primary care has little to do with you. For too long these parts of nursing have been like family members who moved away and lost contact with each other. But as people are discharged home earlier, as more chronic illness management moves into the community and patients choose to be cared for closer to home, these long-lost siblings need each other more than they thought.

Important changes are taking place in primary care that will impact on nurses, midwives and health visitors wherever they work. Over the last year we have seen the role of specialist nurses in the community increase. There is a new contract for general practice that will create exciting opportunities for nursing.

New US models of nurse-led care management for vulnerable older people are being piloted and there has been a big expansion in the role of nurses providing first contact care. At the same time nurses, midwives and health visitors are contributing to integrated health and social care programmes for vulnerable children and adults. All of these changes are supported by ‘Liberating the Talents’ - the new strategy for nursing in primary care which is being taken forward by PCTs all over the country.

What does this mean for the busy nurse in hospital? Faster throughput means knowing more about the patient’s home environment and its impact on health and recovery.

Promoting self-care and focusing on rehabilitation becomes more important. Nurses in specialist roles are moving more into the community and designing care around the everyday lives of patients. But this is a two-way street – at the same time nurses in the community need to understand how new treatments, technologies and working practices are changing the experience for both patients and nurses in hospital.

Nurses in A&E, walk-in centres and general practice are beginning to work together and improvements in discharge practice are being led by practitioners who understand both worlds. Nurses who can work in both settings and make it easier for patients to move between the two will be much in demand in the future. Meanwhile nurses in hospitals should keep an eye on primary care – this may well be where your future lies

A limited number of places for this year’s conference – Delivering the difference together – are still available.

The CNO’s team is urging nursing directors who have not yet registered for the conference to do so as soon as possible.

It is being held at the Grand Hotel in Brighton from 12 to 14 November and promises to be a stimulating, challenging and enjoyable event. Accommodation at the hotel itself is now fully booked.

Any queries about the conference should be directed to Clever Media, quoting ‘CNO conference’ on tel 020 7633 0336, fax 020 7202 2004 or CNOConference@eventsregistration.com

Have your say

The CNO Bulletin is tailor-made for nurses, midwives and health visitors across the NHS. It aims to cover the main topics of interest every month. Let us know about the information that you want to see included.

We also want to hear your views on the subjects covered in the bulletin. You can e-mail chief nursing officer Sarah Mullally direct at CNO-Bulletin@doh.gsi.gov.uk

We'll use your feedback to develop and shape future bulletins. It will also contribute to understanding better the views of NHS employees on current issues.

Please be assured that all feedback is confidential and that any opinions quoted will be featured anonymously.

Top

Subscribe to The CNO Bulletin

E-mail is the fastest and most cost-effective way for us to send the CNO Bulletin to you. Anyone with access to an e-mail address can subscribe and we want to encourage more readers.

How to subscribe

nurse directors should send an e-mail request to dh-test-emails@doh.gsi.gov.uk

all other nurses, midwives and health visitors should send an e-mail request to doh_cno_subscription@talkingnumbers.com

Please provide the e-mail address you would like to use, your name, job title, full name of organisation, full postal address with postcode, plus phone and fax numbers.

These details will be stored on a database held by the Department of Health for future mailings of this bulletin.

If you are a nurse director and your contact details change, e-mail us at dh-test-emails@doh.gsi.gov.uk For all other nurses, midwives and health visitors, tell us about changes to your contact details by e-mailing us at doh_cno_amendments@talkingnumbers.com

Top

Working for the NHS as a nurse or allied health professional is thought to be a rewarding career, according to new research.

It is just one of several findings reported in Looking Good? The Attractiveness of the NHS as an Employer, prepared for the Department of Health and based on research conducted as part of the Policy Research Programme Human Resources Initiative.

The research investigated perceptions of the NHS as an employer for the nursing and allied health professions and 1,356 people provided data.

The best thing about working in the NHS was found to be working with patients. Job security and availability, a good pension, task variety, team working and learning were also mentioned.

Understaffing and associated pressures at work were the strongest barriers to working for the NHS.

The research also looked at how current NHS recruitment strategies could be improved, making it an excellent recruitment tool.

A campaign to attract older workers into the NHS has been launched by South Yorkshire Workforce Development Confederation.

The campaign also encourages those already working in the service to think about their careers whatever their age.

Research by the confederation found 80 per cent of people believe mature staff are reliable and that their life experiences assist with their jobs.

A further study by the Joseph Rowntree Foundation found the NHS to be neglecting the needs of older nurses and failing to make the most of their experience.

It also found much more could be done to retain the services of older nurses – and to tempt back those who have already left the NHS.

Katherine Shirrmacher, project manager at South Yorkshire Workforce Development Confederation, said: "A third of the NHS workforce in South Yorkshire is over 50 so it is important to ensure they feel valued and continue working into retirement without it feeling like a chore."

Matrons based in accident and emergency departments are to share a £2 million fund to improve the patient experience.

The Modern Matrons' A&E Patient Experience Fund is to be spent within the current financial year.

Cash from the fund can be used on tangible improvements including extra cleaning, enhanced painting and decorating, upgrading children’s play areas and drinks and snack machines.

A&E matrons can claim £10,000 per department from their lead primary care trust after discussing the needs with patients.

The Department of Health recommends that matrons get the views of A&E patients by speaking with the Patient Advice and Liaison Service.

A leaflet has also been distributed to all frontline A&E staff providing useful contact details about how to involve patients in decisions about their care and explaining how they may be able to help improve the experience of patients in their A&E department.

A senior nurse has been appointed to improve care for patients receiving accident and emergency treatment.

The new director for patient experience in accident and emergency (A&E) will be Jonathan Asbridge and he will take up his post from 1 October.

A former acting chief executive and chief nurse at Barts and the London NHS Trust, he will have responsibility for raising standards of services for patients and their carers who attend NHS accident departments.

In this role he will be working with chief nursing officer Sarah Mullally, national director for emergency access Professor Sir George Alberti and the NHS Modernisation Agency.

His appointment marks the next stage in the Government’s drive to improve services which has already seen waiting times cut nationally.

Over 11 million people a year use A&E departments in the NHS and a survey in November 2002 showed that patients also wanted better information about their treatment and waiting times, friendly staff, a pleasant environment and better facilities for children.

Jonathan said: "Patients are at the centre of everything we do in the NHS and I am delighted to have this opportunity to help improve their experience of emergency care.

"The A&E department is very often the first impression of a hospital for patients and I am looking forward to working with them and with staff to deliver real improvements.

"When they walk through the door of an A&E department patients will always see things differently to staff who work there everyday."

Jonathan is also president of the Nursing and Midwifery Council, a role he will continue alongside his new appointment.

Following the recent cases where nurses have been employed who are not registered with the Nursing and Midwifery Council (NMC), GPs have been reminded that as part of their duty of care to patients and the public, they – as employers – are responsible for checking with the NMC that the nurse is registered before offering them employment.

Practices will also need to ensure requirements for periodic re-registration have been met.

Although most trusts have good systems for checking registration at the time of employment and ensuring it is maintained by their own staff, it has become apparent this is not always happening in general practice.

PCTs will want to work with GPs to ensure that GP-employed nurses within the PCT are registered with the NMC. Practices would benefit from the expertise of PCTs to help them develop systems and processes to ensure staff are appropriately registered. Sharing expertise in this way would enable PCTs to meet their clinical governance obligations.

The recently published Green Paper announced that the chief nursing officer will review the contribution of nurses, midwives and health visitors to children at risk.

These professions play an important role in providing care and promoting health and well-being and caring for children at risk. The review will look at how their contribution can be strengthened.

It will seek to provide a strategic direction that will support practitioners and those responsible for planning, preparing and deploying nurses, midwives and health visitors to meet the needs of vulnerable children.

The review will engage a wide range of stakeholders, most importantly, children and families, along with professional bodies, the NHS and practitioners.

A major plan within the NHS Cancer Plan is the development of a supportive and palliative care strategy.

One element of this has been to commission the National Institute of Clinical Excellence (NICE) to develop and publish guidance on supportive and palliative care.

This will inform the emerging national strategy and development of standards for specialist palliative care services and help decision making-around service delivery.

The guidance is due to be published early next year and the draft is at www.nice.org.uk

It will include recommendations on service models for palliative care for patients wishing to stay and die at home.

There are challenges related to the delivery of care in the community in some parts of the country.

The Cancer Services Collaborative (CSC) Improving Partnerships programme focuses on palliative care to ensure that better care for the dying is the touchstone for success in modernising the NHS.

The programme will implement the ‘Gold Standard Framework’ and the ‘Liverpool integrated care pathway’. Both will enable more patients to die in their place of choice supported by a multidisciplinary primary care team.

A central budget of £50 million per annum for specialist palliative care from 2003-2006 has also been established.

The joint NHS/voluntary sector National Partnership Group will ensure this significant increase in funding is used effectively.

Did you see the news about…? If you missed an announcement or new development of interest to you, the chances are that it could be listed in The Digest. Each month in The Digest we feature subjects of note including where to obtain more information.

The proposed new NHS pay system (Agenda for Change) has been endorsed by the pay review body for nurses, midwives, health visitors and allied health professionals.

In its annual report, the national pay review body approved Agenda for Change, which is reforming the pay system for these groups of staff and provides a three-year pay award of 10 per cent. The Agenda for Change proposals were supported by an overwhelming majority of NHS staff in a number of recent trade union ballots.

The success of a nurse-led diabetes clinic has attracted international attention.

The Diabetes Centre at Salford’s Hope Hospital, part of Salford Royal Hospitals’ NHS Trust, is being featured in a French television programme about the best practice in diabetes care worldwide.

A study has shown that patients attending either the high blood pressure or cholesterol clinics at the diabetes centre showed considerable improvements in health compared to the usual doctor-led clinics.

Patients also preferred being seen by nurses because it was felt they had more time to spend with them and the clinics were more flexible.

The team is now working with Salford Primary Care Trust to develop nurse-led clinics in the community.

Standards to support the UK antenatal screening programme have been published on the Department of Health website.

These generic and disease-specific standards cover screening for rubella antibody, syphilis, HIV and hepatitis B, the four infections currently included in the UK antenatal screening programme.

Strategic health authorities (SHA) are being asked to nominate one trust (acute, mental health or PCT) to join the programme. The closing date for nominations is 26 September. A number of trusts have already contacted the King's Fund and have been asked to make their interest known to their SHA lead nurse.

The flu immunisation campaign will launch on 1 October this year with TV and press advertising featuring Henry Cooper, as well as advertising on other media such as buses, pharmacy bags and online.

The Department of Health has a new page on its website which sets out the work it is doing to tackle bureaucracy in the NHS.

Radical changes to the way NHS dentistry services are delivered in England are being proposed.

The reforms, which will take effect from April 2005 – subject to legislation – are aimed at reshaping how local dental services are commissioned, improving oral health and meeting the demand for more advanced treatment.

PCTs will take control of the £1.2 billion dental services budget from central government. The proposed local commissioning of services by PCTs is aimed at making dentistry more responsive to local needs.

Guidance on how the NHS can use its spending power as a lever to tackle inequality has been produced by the Commission for Racial Equality.

All NHS organisations have a legal duty to promote race equality when buying in goods and services from outside contractors.

The Commission for Racial Equality has published Race Equality and Public Procurement detailing how organisations can use their spending power and meet their legal obligations.

Local measles outbreaks are becoming more frequent as take-up of the mumps, measles and rubella (MMR) vaccine falls, particularly in cities.

Research from the Health Protection Agency (HPA) found more outbreaks of measles between 1999 and 2002 than in the previous four years.

These include preparing for new and emerging diseases, dealing with threats to health and investigating childhood diseases associated with infection, chemical and radiation hazards.

An extra 38 three-star NHS trusts have been invited to apply to become NHS foundation trusts. These would join the 25 that have already been shortlisted.

The Health and Social Care Bill, which proposes the introduction of NHS foundation trusts, has been passed by MPs. It now goes to the House of Lords before returning to the House of Commons for its final parliamentary procedures.

Amended guidance on how to deal with whistleblowers in the NHS has been issued to protect staff that raise concerns about patient safety.

The guidance is available from the NHS Responseline on 08701 555 455 or by e-mailing doh@prolog.uk.com

The Department of Health’s emergency care website has been revamped to reflect current work programmes and provide a useful area for reports, guidance and toolkits. It is at www.doh.gov.uk/emergencycare/

From December, it will be illegal to discriminate on grounds of sexual orientation in the workplace. Guidelines are at www.gladd.dircon.co.uk/iwl.htm

Online advice for older people
An independent guide to the care and rights of older people has been launched.

Caredirections.co.uk describes itself as the web’s ‘complete guide to the care and rights of the elderly in the UK’.

The department has embarked on a change programme designed to provide more effective leadership to the NHS and social care. The department's overall purpose remains unchanged. It is to support the Government to improve the health and well-being of the population.

The Medicines and Healthcare Products Regulatory Agency (MHRA) is proposing to replace British Approved Names (BANs) with recommended International Non-Proprietary Names (rINNs) for all medicinal substances where BANs are currently used, with the exception of adrenaline and noradrenaline.

Specific guidance for health care professionals will be available later in the autumn.

The Review of Central Returns (ROCR) website has been completely updated to give full guidance on all aspects of the ROCR process.

The website explains why the Department of Health needs the central statistical returns that it asks the NHS to provide.

The IAR lists information resources held by the Government, concentrating on unpublished resources.

It also enables users to identify information held within various Government departments, agencies and other organisations.

The magazines aim to spread good practice, stimulate debate and keep health professionals working in the acute and primary care sectors up to date with the latest developments affecting nurses, GPs, pharmacists and other health care staff.

This event on 12 November is for all levels of staff with an interest in theatres and pre-operative assessment.

The Reducing Cancelled Operations conference, organised by the NHS Modernisation Agency’s operating theatre and pre-operative assessment programme, will introduce delegates to fresh thinking to optimise capacity for day and inpatient surgery.

Through plenary sessions and workshops, delegates will explore the benefits of using teams from abroad, effective use of day and inpatient surgery, increasing bed capacity through pre-operative assessment and the theory of constraints.

The conference fee is £95, contact Kelly Giles on 0116 2225146 or e-mail kelly.giles@npat.nhs.uk

Nurses are among those invited to a conference examining special interest roles within primary care.

It is aimed at directors and senior managers in primary and secondary care, as well as nurses, GPs and allied health professionals who are either already involved in or interested in taking on these roles.

The conference will look at the impact that practitioners with special interests (PwSI) will have on the provision of primary care services.

It is being held at the Brewery, London, on 6 November between 9.30am and 4.30pm.