Diabetes nurses speak out over role substitution
Diabetes specialist nurses, and other experts in the disease, have spoken out against the practice of replacing nurses with nursing associates.
The Diabetes Specialist Nurse Forum UK (DSNF UK), alongside a number of other professional groups, has issued an open letter on role substitution of established diabetes team members such as specialist nurses and midwives, general practice nurses, doctors, dietitians and podiatrists.
“Registered nurses are at the very heart of providing safety critical care in diabetes”
Bethany Kelly
The groups warned that there was a “strong body of research to demonstrate that the current MDT [multidisciplinary team] composition improves clinical outcomes”.
They demanded, in the open letter, better definition of the role of physician associates and nursing associates as “additional members” of the MDT, and said they “should never” be used as substitutes for existing members.
“Substitution could lead to gaps in care and subsequently increased waiting lists, a detrimental effect on physical and mental health outcomes for people living with diabetes and increased healthcare costs, compromising the quality of diabetes care in the UK,” the letter said.
DSNF UK penned the letter after being “made aware” of a community trust in England which was planning to replace community diabetes specialist nurses and “registrar level medics” with, respectively, nursing associate and physician associate roles.
Speaking on behalf of the organisation, Wiltshire-based diabetes specialist nurse Bethany Kelly said such role replacement “risks” care.
Bethany Kelly
“Registered nurses are at the very heart of providing safety critical care in diabetes,” Ms Kelly told Nursing Times.
“The current national diabetes audit data, and a large body of research, highlights that the current MDT design that we have works.”
She added: “Any change to current best practice needs to demonstrate a clear understanding of what new roles would bring. They should not be used as substitutes for existing staff who currently deliver the care.”
Ms Kelly explained that there was worry among diabetes specialist clinicians about the long-term impact of role replacement.
“It takes several years for registered nurses to complete the necessary competencies and reach the high level of skill expected of a diabetes specialist nurse,” she further said.
“Substituting registered nurses for lesser qualified individuals without national scope, could have significant impact on hospital admissions, patient safety and clinical care, occurrence of long-term complications.”
The open letter called for the roles of the physician and nursing associate in diabetes MDTs to be “agreed at national level via [a] defined competency framework”.
Among the letter’s signatories were the British Association of UK Dietitians, the Diabetes Inpatient Specialist Nurse UK Group, TREND Diabetes and others.
Writing on X (formerly Twitter), Professor Partha Kar, national specialty advisor for diabetes at NHS England, added his support for defining a national scope of associate-level clinicians within MDTs, and suggested that this work was already moving forward in relation to physician associates.
