District nurses and health visitors will be scrapped in parts of Scotland this year despite widespread fears the shake-up will erode patient care.
The Scottish Government is proceeding with the controversial overhaul of community nursing even though Shona Robison, now Public Health Minister, raised concerns about the plan when she was in opposition.
Research by Dr Linda Pollock, a recent adviser to the health department, found staff fear work to support vulnerable pensioners and children will suffer.
Four regions will implement the changes, which include rolling the jobs of district nurse, school nurse, health visitor and family health nurse into one, this spring.
Although these areas, Lothian, Tayside, Borders and Highland, are being described as "test sites," staff are concerned once the process of creating a general community health nurse begins, there will be no going back.
Dr Pollock, who was a director of nursing with NHS Lothian for more than 12 years, said: "There is a big fear around that the development sites will start in April and changes will happen over the next two-year period that just cannot be un-done."
GPs have expressed fierce opposition to the overhaul.
Dr Dean Marshall, chairman of the British Medical Association's Scottish General Practitioners Committee, said: "A good district nurse is worth their weight in gold and this is going to take that away."
Queens Nursing Institute Scotland commissioned Dr Pollock to research views on the community nursing shake-up last year and she collected the views of more than 60 people including nurses and NHS managers.
She said: "There is a huge fear the existing training for health visiting and district nursing will just wither on the vine."
In a paper on her work, published in magazine Scottish Primary Care, Dr Pollock described concerns about how the generic community health nurse would be deployed.
She said: "Existing district nurses and health visitors stated that they did not have the expertise to care for children - sick or well - or young people. Many did not understand where the future role of school nurse would fit in."
Dr Marshall said: "I have not spoken to anyone who thinks this is going to improve where we are. It is actually going to fracture primary care health teams, which actually function pretty well and have developed good working relationships over the years."
He added that the care-giving role of nurses was being devalued.
Ms Robison had expressed concern school nurse work could be diluted under the new set-up, when she was the SNP's shadow health minister.
Dr Pollock found staff feared the least urgent work, such as supporting vulnerable families or helping patients manage long-term conditions, would be neglected.
She said: "The big fear of everyone is that it just doesn't seem logical to combine four roles into one and that something will be left off."
Experts say a shortage of nurses, due to the number approaching retirement, is behind the plan. The community nursing review paper, which proposed the changes, said families were confused by different nursing roles.
A Scottish Government spokeswoman said: "We are aware that some staff have anxieties about the proposed changes to community nursing and that is why we have taken the decision to test the new model to demonstrate what works and to get it right for the future.
"The model will continue to be tested in four pilot sites over the next year which will allow an informed decision to be made in spring 2009 about the future of the community nursing service."
She added that the changes responded to what patients and health professionals said they needed during a consultation on community nursing.
But she said ministers were keeping "an open mind," with future decisions determined by the result of the pilots.
The tasks
District nurse.
2631 in Scotland. Provides skilled nursing care, practical advice and support to patients and carers in their homes or in residential care. They teach patients to care for themselves.
Health visitor.
1826 in Scotland. The role is about the promotion of health and the prevention of illness in the community. They can provide support on a one-to-one or group basis and target the wellbeing of children, pregnant women and the elderly.
School nurse.
421 in Scotland. They provide services such as health promotion, sex education, developmental screening, undertaking health interviews and administering immunisation programmes.
Family health nurse.
Small number in Scotland. Largely based in rural parts, they were developed as a pilot for a new "generalist" working to improve health.
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