Practical tools for defending specialist nurse posts
This page is based on a resource originally co-developed by the MS Trust, Parkinson’s UK, Epilepsy Action and Epilepsy Society in 2014. We hope this key information and helpful tools will be useful to MS specialists who are facing threats to their service.
5 minute read
Common challenges to specialist services (more information on each below):
- Downbanding – changing the pay structure of a role to a lower grade
- Redundancy or a reduction in team size
- Despecialisation – moving a condition-specific service to covering a range of conditions for example altering a job title from MS Specialist to Neurology nurse
- Redeployment – asking specialist nurses to take on additional duties
- Impending vacancy – when there are no plans to fill a role that a nurse is leaving
- Change of employer – another provider taking over from your existing employer
For further support, please do not hesitate to contact our Health Professionals Programme team.
Making your case
- prepare brief factual evidence that supports your case including your caseload, key responsibilities etc.
- avoid personal terms such as I, we, me, us or our and steer clear of emotional statements or responses, always refer to 'the service'.
- paint a realistic picture of the new service, ensure patients and service users are aware of the potential for a reduced service in future and that you will be unable to continue to provide everything as you do now.
- remember the 'bigger picture' and the risks for your employer, because it will help shape your response appropriately. Consider NICE guidance and key NHS documents, such as the 10 Year Long Term Plan (2019). Consider the wider financial implications of the proposed changes.
- think about making joint submissions e.g. with other condition-specific neurology nurses.
- ensure your submission stands out. Management may be receiving lots of reports from specialist nurses – what makes yours different?
- offer an alternative scenario only if this is suitable for the service and the team e.g. reduced hours in condition specific nursing and some hours offering a general neurology nurse specialist service.
- talk to your national patient organisation (e.g. MS Trust) at all stages of the process.
Gathering and presenting evidence
1. Describe the threat
2. Describe your service in 500 words or less (here’s a generic description which you can amend)
3. Describe the risk (here’s a sample risk assessment)
4. Describe the consequences (here are some examples). The risk assessment at step 3 should help here.
5. Summarise the arguments. List what you have found in key bullet points. Include any direct financial consequences you know will result (our cost saving table may come in handy here).
6. Write an executive summary in 200 words or less (here are some examples) It helps to keep your document short and concise to make sure that your Managers are able to read it and absorb the key points easily and quickly.
Using the evidence you’ve collected using the steps above, write a business case structured as follows:
1. Executive summary
2. Describe the threat
3. Summary of arguments
4. Description of service
5. Description of risks
6. Description of consequences
Then finally… submit your document!
Ensure you know who should receive this, eg local management, senior management, commissioners etc. The MS Trust can help you identify your key stakeholders if you aren’t sure.
Challenges to services
Downbanding or downgrading a job means changing the pay structure of the role to a lower grade. At the moment, NHS staff are placed on a national pay scale by reference to a UK-wide NHS job evaluation scheme. The scheme ensures that staff doing the same job in different places are paid the same.
Budgetary pressures on employers mean they may downband existing staff as a way to increase the workforce.
You should receive notice of the intention to downband your role. Start planning as soon as you receive notice of the process. (See above)
“Being made redundant means your job is no longer available. Redundancy is different from being sacked or dismissed. If you are dismissed your employer is getting rid of you, but if you are made redundant then your employer is getting rid of your job.”
There is a set, legally required process for making redundancies. Normally this will need your employer to notify you several weeks in advance that redundancies are being considered (depending on the number of redundancies) and which roles/services are under consideration.
Start planning as soon as you receive notice of the process via briefing/email/newsletter.
Despecialisation is our term to describe when a post or service is threatened with moving from being an MS nursing or AHP service to a neurology nurse/AHP specialist post that covers a number of conditions.
You should receive some notice of this planned change. Use this time to get prepared, and start planning as soon as you receive notice of the process.
Redeployment is our term for when the specialist nurse post is asked to take on additional clinical duties which detract from their specialist nurse role. The commonest example is being asked to work on the wards.
You may receive some notice of this change. Use this time to get prepared, and start planning as soon as you receive notice of the process.
An impending vacancy arises when a specialist nurse is choosing to move on, and there appears to be no plan to fill the role. This can have significant knock on effects, such as:
- External move or retirement – specialist nurse moves on, leaving the team with a gap in service or no service for an extended period of time
- Retire and return – the specialist nurse or AHP retires and returns (usually on 2 days a week) but there may be no immediate plans to advertise for a post to fill the remaining 3 days a week that are now vacant
Occasionally an impending vacancy is known about in advance, for example for a planned retirement. To anticipate these occasions, preparing a succession plan is useful.
Depending on the situation, it may not be appropriate to complete a full case to make to management about why the specialist nurse role should be retained. For example, for a lone practitioner it may be more appropriate simply to leverage support to clarify the situation.
If the vacancy occurs in a condition-specific or a mixed neurological specialist nursing team where the loss of one specialist nurse will lead to other nurses picking up the extra workload, you may need to make a full case. This may also be an opportunity to consider whether you want to replace like for like or whether, as a team, you might be better served by creating a part time Band 6 post and increasing the DMD coordinators hours (for example).
identify what outcomes you want from this, for example
as a service leader you may want
- commitment from management to continue service/role
- commitment from management about when they will advertise
- commitment from management about type of role eg banding, previous experience
as an individual nurse moving on, you may want
- guaranteed end date
- some idea of future plans, so you can keep patients informed
- an ongoing care plan for existing patients eg point of access to services
These outcomes will define your approach.
Change of employer
Change of employer is defined here as an independent provider taking over the contract from an existing NHS employer. An independent provider may be a commercial company such as Virgin Care or Serco Health or a social enterprise such as Bromley Healthcare or Bristol Community Health. All of these will be working towards outcomes set by the commissioners and will need to provide evidence that these have been met.
We are not in a position not offer legal advice if you are placed in this situation. Our aim is to outline possible concerns that may arise from a transfer, and opportunities available to you to deal with any challenges.
Transferring employees across two organisations
Employees are protected by TUPE – the Transfer of Undertakings (Protection of Employment) Regulations. These regulations are designed to protect the rights of employees in a transfer situation, enabling them to secure the same terms and conditions, with continuity of employment, as they had with their former employer. Pension rights are not so clear –make enquiries with your new employer.
The potential risk with a change of employer, is that once employees have TUPEd across, the new employer will start considering downbanding, despecialisation or redundancy of your role or service.
Therefore, the challenge with a change of employer is to anticipate or discuss the likeliest threat, and get your materials and support together in advance.
So, start planning as soon as you receive notice of the process via briefing/email/newsletter.
Type of independent provider
Consider the type of independent provider you are transferring to as this may indicate whether your role is likely to be at risk.
1. commercial company - companies are required to produce value for their shareholders, through dividends and rising share prices. Consequently the employer may be looking to cut costs, so there is a risk of downbanding or redundancy and/or redeployment. Follow the steps available through those links to combat these threats.
2. social enterprise or a not-for-profit organisation – this is an umbrella term for a number of organisations such as community interest companies and some charitable organisations. The bottom line is that social enterprises make money from selling services (health services to commissioners), but instead of paying dividends to shareholders, reinvest the profits back into the business to improve services. If you are transferred to a social enterprise, it will be very important to make your case for continuing the specialist nurse service to ensure that it is not threatened: financial viability is vital. It may be worth following the downbanding links to create your case. It is vital that you align any objectives or outcomes set by the commissioners/CCGs of the specialist nursing service with those of the social enterprise.