The future for general practice nurses

As a dynamic group of professionals, General Practice Nurses (GPNs) continue to develop apace with the ever changing landscape of the NHS. However, with a Queen’s Nursing Institute (QNI) survey revealing that over 33% are due to retire by 2020, there is a pressing need to ensure that sufficient numbers are attracted to the profession. In this feature article, Deborah Bellamy, Primary Care Business Manager, explores how General Practice Forward View sees the ongoing GPNs and how other frameworks and plans are contributing.

In General Practice Forward View (2016), the NHS acknowledges the need to support and expand general practice and address wider primary care staffing issues to tackle challenges faced and meet the increasingly complex needs of patients by growing staff numbers and better utilising skills of the wider workforce. This will involve investment and development of multidisciplinary training hubs.

Ambitious plans to create an additional 5000 doctors’ posts in general practice by 2020 and a minimum of 5000 other staff by 2020/21 which include mental health therapists, clinical pharmacists and medical assistant roles to support GPs.

There will also be considerable funding for practice manager and clerical staff development. A multidisciplinary community provider contract is being developed creating new clinical models with a wider range of specialist services with integrated community-based teams and access to step up step down beds.

A GPN development strategy is included which comes with an additional £15 million of national investment earmarked with enhanced retention schemes to help keep the existing nursing workforce and also to support a return to work scheme for GPNs.

There is a need to improve nurse training capacity within general practice settings and expand numbers or preregistration nursing placements. Increased collaboration with practices will be necessary to ensure that GPNs have access to mentorship training schemes.

Interestingly, the QNI survey found that only 27% of the employers offered placements for preregistration nursing students, as opposed to over 60% offering placements to medical students. In order for numbers of preregistration student places to be increased, issues around mentor training, support and capacity for GPNs will need to be addressed, as echoed by the Royal College of General Practitioners (RCGP) 10-point plan.

RCGP 10-point plan

The RCGP devised a 10-point plan: Building the Workforce — a New Deal for General Practice, to kick start the initiatives around recruitment and retention. The Royal College of Nursing and Queen’s Institute have been involved in creating a range of diverse workforce models and have been looking at wider issues such as workforce planning, key to ensuring sufficient practice nurses for the future.

Further roll out of Health Education England career framework for PNs

With regards to career progression and as part of recruitment and retention for GPNs, the 2015 Education and Career Framework, launched by Health Education England (HEE), outlines specialist knowledge and skills needed to deliver and develop in district and general practice nursing. It establishes key responsibilities and roles at each level from a concept which resulted from the Transforming Community and Primary Care Nursing initiative when it became clear that district and practice nurses have different skills and work streams.

The District Nursing and General Practice Nursing Service Education and Career Framework underpins a move from acute to primary and community care focus by setting out the standard roles and responsibilities and outlines a career pathway.

The framework is split into two sections, one for practice nursing and one for district nursing. The pathway begins with healthcare apprentices and assistants at levels one to three, moving up to advanced nurse practitioners and nurse consultants on levels eight and nine correspondingly.

Each section divides into nine defined levels, similar to the bandings in Agenda for Change, although this is not linked to pay grades.

To enable nurses to develop their career and move up the scale, supplementary professional and clinical skills will be essential. For example, if a GPN aspired to become a nurse practitioner, he or she would need to demonstrate competencies in wider areas than clinical skills, such as leadership and management of a practice team, as well as the ability to prescribe.

It is hoped that this framework will be useful for employers and practice managers to glean a better understanding on what it means to be a nurse practitioner, practice or district nurse or nurse consultant in a primary care setting.

The Queen’s Nursing Institute survey findings

In January 2016, the QNI reported the results of an online survey completed by over 3400 GPNs during 2015, General Practice Nursing in the 21st Century: a Time of Opportunity on Practice Nurses as a profession. The survey findings highlight challenges of an older population with many complex healthcare needs.

Positive outcomes include that 53% felt that their employer always supported their professional development needs. However, 43.1% feedback that they did not feel their nursing team had the correct number of appropriately qualified and trained staff to meet the needs of patients.

During 2016, the QNI will collaborate with QNI Scotland to produce new Voluntary Standards for General Practice Nurse Education and Practice which will enhance the existing Nursing and Midwifery Council (NMC) specialist practice standards for General Practice Nursing.

To support those new to general practice, the QNI launched a free online learning resource for nurses, Transition to General Practice Nursing, which can be found on its website.

Nursing framework based on 10 commitments

This aspiration framework focuses on 10 commitments set out by the Chief Nursing Officer for England in a four-year plan for nurses, midwives and care workers centred on reducing unjustifiable disparities in both health and care provision, managing health and equipping patients to make informed choices working in partnership with patients’ families and communities, preventing poor health and maximising technology opportunities. Safe staffing and education and training are also key in promoting a culture where improving the population’s health is a core component of practice.

Leading Change, Adding Value is the replacement for 2012 Compassion in Practice Strategy and focused on 10 commitments, which include having the “right staff in the right places at the right time”, leading research to show the impact of practice.

This framework focuses on the impact nursing has, how it can alter service provision and recognises the pivotal role that nurses, midwives and care staff have across all care settings.

Mandatory training

It has been acknowledged that there has been an increase in the mandatory training requirements for PNs which include subjects such as basic life support, safeguarding, information governance, health and safety, complaint handling, fire and fridge requirements. While accepted that this is necessary, it is envisaged there will be more targeted training while taking into account revalidation requirements.

Mandatory training not directly related to practice, such as fire training or health and safety, may no longer be included as part of the 35 hours of continuing professional development (CPD) needed for nurses to revalidate. Conversely, if mandatory training supports and enables practice development, it may count towards the required CPD hours. An example of this could include attending mandatory training on safeguarding when working with vulnerable groups.

Revalidation proving an initial success

Although there was some initial anxiety about the new revalidation process, which replaced the old PREP system in April of this year, the NMC reports 90% of nurses expected to revalidate in April completed the new process successfully and have remained on the register. The NMC also suggests there has been positive feedback from those who have gone through the process which looks set to be a “major success”.