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Gold, incentives and meh

If GPs gave practice nurses better training and support, they could transform primary care

Shared staff and opportunities to progress professionally could help nurses step up to the challenge facing primary care at the moment, writes Caroline Alexander

With a growing and ageing population, more long-term conditions and stark health inequalities, London’s primary care is under unprecedented pressure.

In November 2013 we launched our General Practice – A Call to Action, which invited CCGs, GPs, patients and other bodies to begin discussions about how to improve GP services in London.  These conversations must cover the challenges facing the workforce, and practice nurses are at the heart of this.

With 90% of all patient contacts occurring within general practice, practice nursing is a great opportunity for nurses to work at the heart of the community, with exposure to a wide and varied case load and the opportunity to make a difference to the outcomes of patients.

However, many are put off by a perceived lack of training and support in the profession. By increasing opportunities for nurses to train with GPs, as well as better support for practice nurses in training and on the job, we could encourage more nurses to build rewarding careers in primary care.

In London, the number of people over the age of 65 is set to increase by 19% by 2020 and long-term conditions are also on the rise, and the situation is similar across the country. To meet this challenge, the workforce will need to be developed to include systems of mentorship, supervision and support for practice nurses.  There are a number of ways in which this can be achieved – for example, practices working closely in groups will tackle the issue of isolation among nurses, allowing them to share best practice and support each other, as well as enabling them to develop specialist interests across a wider community.

Workforce crisis looms

With more nurses leaving the UK each year than arriving from abroad, there are staff shortages across the profession and this is acutely felt in primary care. Furthermore, a potential retirement bubble is looming, with many older nurses concentrated in primary and community care. We desperately need to attract more student and newly qualified nurses to pursue a career in general practice, and training is key to this.

Student nurses currently have little exposure to general practice, and although there is an increasing emphasis on community exposure, training is still overwhelmingly focused on hospital settings. If we are to make practice nursing an attractive career choice for these nurses, we need to enable them to experience the benefits and challenges of the role from early in their training.

There is also an urgent need to develop more bespoke training programmes in primary care, as well as increasing opportunities for nurses to train alongside GPs. There is currently a lack of standardised training programmes in practice nursing for nurses who have already qualified, such as experienced nurses looking to move from acute settings into primary care.

There are a few examples of these kinds of training schemes rolling out – for example the Primary Care Placement pilot (placements in primary care settings for both pre and post registration nurses) and the Open Doors programme (supports the transition of nurses into primary care and leads to a BSc (Hons) in Primary Care (Practice Nursing)) – but more needs to be done. For initiatives such as these to work, we’d like to see more GP practices working with universities and training providers to support the development of practice nursing.

Alongside a lack of training available for aspiring practice nurses, we also need to work with GPs to help improve support and professional development for nurses in their practices.  We held a focus group with practice nurses from across the capital which highlighted low morale and scope for further professional development support for this workforce, as well as concerns about isolated working, a lack of career progression, and gaps in basic clinical governance. Something needs to be done to make practice nursing an attractive and long-term career option for talented nurses who want to work at the heart of the community.

All sections of the health service need to think creatively about how to make the most of the current workforce, and how this should look in the future. Focusing on the wider workforce would relieve the pressure currently felt by the GP workforce, not only in London but across England, but to make this ambition a reality GP support is crucial.

Caroline Alexander is the Chief Nurse in NHS England’s London region.

Readers' comments (19)

  • Thanks Beverly for your support. lets have a bit of team spirit! GP's and nurses are working towards one common goal ... achieving the best care and outcomes we can.

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  • Most GP's i've worked with are oblivious to the role of the practice nurse! But they are well aware of our value when it comes to QOF! And most do not release nurses for training and tend to work their nurses in to the ground. Good GP employers are few and far between.

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  • as for vocation! get's a career and a job.

    Easy to say nursing is a vocation when you are earning 100k a year and the practice nurse is pulling in 25k if she's lucky!

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  • As an ex BSc Health Studies( General Practice Nursing) Senior Practice Nurse of 16 yearsand local Health Board Practice Nursing Advisor, I would agree that nurses could be used more efficiently within the practice. I found the the Skill Mix model worked well with a well qualified leader ensuring training, conditions/pay was appropriate for each post. GPs after found it hard to understand that it is the job that is graded and not the candidate. Nuses now have many more opportunities than in the past and perhaps Doctors and Nurses must remember we are all professionals and not the "handmaidens" we sadly are still often though of! A good team Iof GPs and Nuses makes a good practice, not forgetting a well trained manager!

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  • I work 10.5 hour days with 30 min unpaid lunch break as PN.
    Typically see 35 patients daily with 10 minute slots.Dna and free slots(what are they my patients like me too much) spent summarizing and preparing for travel clinic and CQC visit.Protected learning not available mandatory only.Colleagues in secondary care now earning about 3k mor than me. Dont get me wrong enjoy my job but just beginning to view retirement in distance after 30+ years as nurse

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  • I think GPs and practice managers struggle to plan for the future and identify a good skill mix when employing new staff. No doubt this is difficult but sometimes it might be worth asking the current staff what they think is needed. I work in 2 practices and there is definitely room for improved forward planning.

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  • I agree there is much potential in the nursing force in general practice. It is a shame GPs don't invest a little more time in their staff in terms of support and mentoring to maximise their skills and reduce their dependency on GP locums.

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  • Nurses have enough to do as it is most patients think they have a right to see a GP.
    I think everyone in the NHS is sick to death of changes and the insecurity that comes with them, why don't we ;eave GP's to decide how best to care fro their patients?

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  • I love the job of being a PN, but I also have management interest and experience. Unfortunately, any ideas I put forward are quashed by the practice manager. This has happened to me with 2 x managers because I suspect they think they are relinquishing what they see as their power dept.. The GPs just do not see it because the manager is always put between I and "The Partners".
    It feels quite odd that I am trusted clinically to make clinical decisions, run clinics alone, yet I am made to feel like a child if I express any "management" opinions.

    GPs, please include your practice nurses in meetings, even the MONEY ones. I, for one, like to be part of the team not outside of it.

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