Building a recognised and valued pathway to becoming a DSN

The NHS White Paper Equity and Excellence: Liberating the NHS (Department of Health [DH], 2010), published in July and out for consultation until October, promises to radically change the NHS. Its proposals include putting patients at the centre of health care, giving greater focus to clinically based patient outcomes, and empowering healthcare professionals. The way services are commissioned will pass to GP consortia, and opportunities for new providers, including the private sector, will increase choice and competition. Choice and competition are exciting concepts that drive cost-effectiveness and innovation but also lead to a focus on “what you get for your money”. Demonstrable outcomes and evidence of fitness for purpose will be ever-more important in this new NHS. 

The White Paper does not, however, specifically mention nurses. Yet, in this period of change, the need to address issues such as the enduring concerns about defining the role of the DSN, confusion about the numerous titles for the specialty, recent cutbacks in DSN posts, and the lack of an established route to accreditation or recognised education pathway, is becoming more urgent.

An Integrated Career and Competency Framework for Diabetes Nursing was revised in February 2010 by TREND-UK (Training, Research and Education for Nurses in Diabetes-UK), with input from representatives of the main nursing groups in diabetes in the UK, and people with diabetes. The framework sets out what level of competency is expected for various aspects of diabetes care delivered by the unregistered practitioner, competent nurse, proficient nurse, expert nurse and nurse consultant. This document has been accepted by the Diabetes UK Education Task and Finish Group as a model for all healthcare professional groups working in diabetes, including doctors. 

As well as guiding nurses through a career pathway towards diabetes specialism, this tool also provides guidance for commissioners in knowing what level of staff is required to deliver services (and “what you get for your money”). However, without a clear education pathway, it is hard to demonstrate “fitness for purpose”.

The co-chairs of TREND-UK, with academic expertise provided by Professor Sir George Castledine from Birmingham, Professor Molly Courtenay from Surrey University and Anne Phillips from York University, met at the end of July 2010 to consider the development of an education pathway for nurses working in diabetes – this is well-established for medical staff working in diabetes. The group aimed to:

• Explore what educational pathways are established elsewhere (in the USA and Europe).
• Review the numerous diabetes courses available.
• Identify gaps in current education provision. 
• Match available courses to the requirements of the competency framework.

An action plan was then formulated to:

• Work with education institutions to identify courses that meet the requirements of each level of competency and develop a means of accreditation or “kite-marking”.
• Work with the Nursing and Midwifery Council, Diabetes UK, NHS Diabetes and the DH to embed an accredited pathway for nurses into diabetes services, possibly resulting in a recognised qualification in diabetes nursing.

This education working group aims to produce a draft pathway for distribution to stakeholders and nursing group representatives for discussion, identification of potential barriers and concerns, and novel ideas for improvement, by early 2011. This document will sit side-by-side with the competency framework. These initiatives provide the opportunity to build a recognised and valued pathway to becoming a DSN. They will also provide clear information to service users and commissioners on what each level of nurse working in diabetes care is qualified to deliver. 

This project, along with the established competency framework, will address aspects of the White Paper such as putting patients at the centre of health, giving greater focus to clinically based patient outcomes, and empowering healthcare professionals, and will provide nurses working in diabetes care with the tools to remain fit for purpose in this new emerging NHS.