Peter Lapsley: Degrees of care

Peter LapsleyThere have been mixed messages from the Patients Association in response to the announcement of plans for nursing in England to become an all-graduate profession. Writing in The Times on 12 November, the Association’s director, Katherine Murphy, said the move had “sent out all the wrong messages, as it has become more important to write about care than to give it”. In contrast, their vice-chairman, Mike Summers, welcomed the move, saying he didn’t think, “…anybody could really complain about nursing being taught to a high level.” Neither mentioned an essential point, apparently missed by other commentators, too, that common sense suggests that you cannot increase recruitment to a profession by making it more exclusive.

Nursing is facing a workforce crisis. An ageing population will increase the numbers of nurses needed, especially in primary care, to which much responsibility for healthcare is being shifted. The RCN says that 30 percent of all British nurses are aged 50 and over and will retire within the next ten years. Where practice nurses are concerned, the proportion is even greater. In January this year, King’s College, London reported that applications for nurse training in the UK had fallen by 26 percent between 2003-7, that there would be a shortfall of up to 14,000 nurses by 2011 if there was no increase in the number of applications, and that the problem was expected to become even more acute thereafter. To my layman’s eye, it seems likely that the requirement to obtain a degree before entering or re-entering the profession could only exacerbate the problem.

There must be in the community large numbers of people who trained as nurses and then left the profession, often to raise families. It is not unreasonable to suppose that many of them would be pleased to return to it – perhaps part-time – provided they did not have to clamber onto an academic treadmill. Of course, they would have to undertake a Return to Practice programme to refresh their memories and bring them up-to-date, and to continue their professional development thereafter. But that seems far more realistic and far less onerous and off-putting than having to obtain a degree.

Within the police service, the rank of constable is highly respectable and respected. A police officer is free to choose whether to remain a constable, perhaps training in a variety of specialist areas, or to embark on the succession of exams that are necessary for climbing the promotional ladder. I cannot believe that nursing is very different. Nor can I believe that the Nursing & Midwifery Council is determined to turn a recruitment crisis into a workforce disaster. Perhaps they would like to think again.

Peter Lapsley is patient editor of the BMJ.