It is hard to ignore the politics in nursing.  Every time a qualified community nurse leaves, they are replaced by an untrained Health Care Assistant.  What is going on here?  I do not want to do HCAs down, as many of them do a superb job, but if the job can be done as well by an HCA as a staff nurse, then what is the point in spending three years studying and living on a student grant.  Are the accountants taking over primary care?  Do ‘they’ not realise that carrying out nursing interventions requires more than mechanistically following a care plan.  A few days ago we all trooped to the hospital to listen to the senior manger explain how primary care is moving to a commissioner –  provider model.  Now having been a manager myself in a previous life, I have more sympathy than most for these unfortunate, overpaid individuals, but their talk of corporate identity, metrics and strategic positioning was a real turnoff for us clinicians.  “Tesco,” lectured the speaker, “can sell holiday insurance, mobile phones, in fact almost anything.” The bewildered nurses gazed at each other as the quagmire of mutual misunderstanding between speaker and audience widened.  They had signed up to care for sick patients, were they to sell insurance?  “We must all review our strategic marketing position,” burbled the manager from another planet, but it was too late, the audience was lost.  “We must leverage our core competencies to create a paradigm shift,” she pleaded faintly. To be fair, she had little hope from the start.  The majority of nurses, I believe, nurse because they care about patients, and have no wish to become business savvy; it is incompatible with their approach to patient care.  If we must run like a business, so be it, but nurses should focus on what they are trained for and do best, and accountants should allow them to do so.