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.