Implications of the new NHS contracting system for the district nursing service in one health authority: A pilot study

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Abstract
This paper discusses aspects of a pilot study which investigated the implications of the NHS reforms in one health authority. The impact of contracting on the district nursing service was examined from purchaser and provider perspectives. The study also sought to identify the optimum approach district nurses should adopt towards contracting in order to sustain quality of care. The district nursing service was chosen as a case study from which the implications of contracting for other primary health care occupations could also be examined. We adopted a qualitative research approach drawing on sociological traditions, action research and ethnomethodology. Methods included participant observation, group discussion and questionnaires to document and describe district nursing work. Interviews were used to investigate purchasers' perspectives on contracting. For the purposes of this paper we draw on observation and interview data to discuss the impact of contracting on district nurses from a number of perspectives. First the content of district nursing work is examined and compared with current information systems being developed to specify and monitor contracts. Second we map purchasers' views on setting needs and priorities in the contracting process. Because of the divergence amongst the purchasers their views are considered along a spectrum. Finally we explore the implications of the findings for contracting and the nurse's role.