Last reviewed 10 October 2017
In this feature, Thoreya Swage, healthcare consultant, describes the 10-point action plan for general practice nursing in England which sets out the changes needed to increase the recruitment, retention and return to work of nurses to general practice.
It was recognised in the General Practice Forward View (GPFV) — NHS England’s five-year strategy for primary care — published in April 2016, that general practice required a significant boost in order for it to be able to meet the challenges faced by the NHS in the future. In particular, the focus needed to be on enhancing the workforce.
The GPFV highlighted a need to improve practice nurse development through a range of means such as increasing the number of pre-registration nurse placements, developing initiatives to enhance nurse retention, improving support for practice nurse return to work schemes and practice nurse training. This was coupled with extra investment nationally of £15 million.
There is a growing recognition that the development of practice nurses is vital to the improvement of primary care delivery as they are a key element of the GPFV aim of delivering innovative health and wellbeing services in the community. It is also essential in the support of the continued development of primary care hubs that are being established across the country by local Sustainability and Transformation Partnerships (STPs) and for the enhancement of practice networks or GP Federations.
In March 2017, Health Education England (HEE) published General Practice Nursing Workforce Development Plan — Recognise, Rethink and Reform which identified a number of recommendations for organisations influencing the practice nursing workforce. The areas covered include encouraging newly qualified nurses to take up practice nursing, better induction, access to preceptorship programmes, appropriate training and education, identifying practice nurse leaders, promoting clinical academic careers in primary care and appropriate training for healthcare assistants.
Research by Ipsos Mori in August 2016 revealed that newly qualified nurses viewed general practice as “risky”, the role was unclear and much of it involved working in isolation. The Queen’s Nursing Institute, in a survey of over 3400 registered nurses conducted in January 2016, found that 33.4% of practice nurses were due to retire by 2020. If extrapolated, this figure means that over 8000 practice nurses could be leaving primary care in the next three years.
NHS England’s plan to develop practice nursing
In response to HEE’s document, General Practice Nursing Workforce Development Plan — Recognise, Rethink and Reform, NHS England published General Practice — Developing Confidence, Capability and Capacity: A Ten-point Action Plan for General Practice Nursing in July 2017 which set out the changes needed to increase the recruitment, retention and return to work of nurses to general practice. Supporting this is the intention to publish a target for the number of extra practice nurses that will be employed in primary care by 2020–2021.
The 10-point action plan for general practice nursing
The 10 action points for general practice nursing is summarised below.
Promoting general practice nursing.
NHS England will be leading a multi-media campaign nationally to promote general practice as a first career destination for newly qualified nurses, as well as developing an online toolkit which is continually updated to support the recruitment and retention of practice nurses.
Local STPs will be asked to develop practice nursing workforce plans by April 2018.
HEE has published a document called the District Nursing and General Practice Nursing Service Education and Career Framework which supports this initiative. The framework explains clearly core and specific roles of these nursing groups and is based on the four pillars of practice for registered nurses. The four pillars are: leadership and management; facilitation of learning; evidence research and development; and clinical practice which is specific to each nursing role. For the practice nursing role, the career progression that is illustrated in the framework begins at the pre-employment level and goes through seven other levels, including healthcare assistant, assistant practitioner, general practice nurse and advanced nurse practitioner.
Leadership and educator roles for practice nursing.
Practice nurses will be supported in developing their role through better access to leadership programmes and the establishment of a practice nurse educator role in each Clinical Commissioning Group (CCG). In addition, practice nurses will be encouraged to engage in national development programmes aimed at transforming care, long-term conditions and care of older people.
Increase pre-registration nurse placements in general practice.
Through the four regional General Practice Nursing (GPN) Delivery Boards set up by NHS England employers will be supported to increase the overall numbers of pre-registration nurse placements.
HEE, through the training hubs, has been given a target to increase the number of pre-registration nursing placements in general practice by 15% above the baseline (as a minimum) in the first year moving to 20% in the second year.
Establishment of inductions and preceptorships.
NHS England will be required with partners to identify and share good practice in attracting newly qualified nurses into primary care, and all new general practice nurses are to have access to an approved employer-led induction programme and continuous professional development (CPD) plan. In addition, healthcare assistants (HCAs) are to have access to Care Certificate training so that they are trained to a recognised minimum standard.
The outcomes of Care Quality Commission (CQC) inspections will be used as a lever to improve clinical standards and practice.
What is preceptorship?
Preceptorship is a phase of transition for newly registered nurses and allied health professionals following qualification to enable them to continue their professional development and building their confidence and competence to practice.
Enhancing “return to practice” for practice nurses.
Ensure that the “return to practice” programme led by HEE includes primary care and that the Nursing and Midwifery Council (NMC) enables these nurses to register and are supported through revalidation when necessary.
Improve health prevention.
Public Health England (PHE) is developing a new online “All Our Health” learning platform to embed and extend disease prevention, wellbeing and health protection in primary care, with a focus on the role of practice nurses. The aim is to ensure that every patient encounter is productive, with particular emphasis on management of obesity and anti-microbial resistance.
Educational programmes to deliver the FYFV national priorities.
The Regional GPN Delivery Boards will lead on developing and enhancing access to programmes to enable practice nurses to improve their skills in areas such as using practice population health profiles, coaching (virtual and group) and patient consultations using digital technology. In addition to providing advice on health promotion and prevention to patients, practice nurses will also be required to develop skills to support people with long-term conditions (including case finding and self-care) and act as care co-ordinators for people with multi-morbidity and frailty.
Clinical academic careers, advanced clinical practice programmes and advanced practice roles in primary care.
HEE is required to lead on the development of clinical academic career pathways so that nursing research in primary care is enhanced through greater numbers of clinical academic nurses in general practice. In addition, advanced clinical practice will be promoted to support an increase in the numbers of these roles in primary care.
Developing other roles such as healthcare support workers and nurse associates/apprentices.
These other roles include healthcare support workers (HCSW) and nurse associates or apprentices. Using the District Nursing and General Practice Nursing Service Education and Career Framework HEE will be promoting career pathways to enable staff to work from Care Certificate level to apprentice or nursing associate and onwards to a graduate nurse qualification.
The four GPN Regional Delivery Boards working in conjunction with HEE will introduce the nursing associate role into general practice.
Enhancing retention of practice nurses.
NHS England will be leading this action to improve the retention of practice nurses in primary care together with commissioners, NHS Employers and professional bodies. This will be through the promotion of general practice as a good place of employment for practice nurses and HCSWs through initiatives such as:
developing a model contract of employment for practice nurses
ensuring that primary care has access to the “Culture of Care” Tool developed by King’s College, London, which helps organisations assess the culture of care they provide through discussion and reflection
implementing the practice nurse career framework including the use of competence based job profiles
measuring the development of the practice nurse workforce including numbers and role profiles
setting up clinical supervision in primary care for practice nurses and HCSWs
supporting and promoting successful initiatives and good practice that relate to the retention of practice nurses.
NHS Improvement will be leading on the development of a safe staffing resource which will bring primary care into line with other safer staffing resources that are currently implemented in other care environments such as hospitals.
To support the implementation of the 10-point action plan for practice nurses work will be required by NHS England, HEE and PHE to gather information and in setting baselines and monitoring on a number of areas including:
sharing best practice
identifying practice nurse workforce profiles and numbers
developing metrics to assess the implementation of “All Our Health”
developing metrics to measure the numbers of practice nurses leading on initiatives such as frailty assessments, annual health checks for people with learning disabilities and physical checks on people with severe mental illness.
There is an expectation that many of the actions will be completed by April 2018, with the remainder at the latest by January 2019. A list of target dates with actions is set out at the end of the 10-point plan document as follows.
The four Regional GPN Delivery Boards to be set up
The Higher Education Institutions that will deliver the general practice “return to practice” programme to be identified
Establish the following baselines
The number of GPN educators working in CCGs supporting general practice nursing to be mapped
A competency-based preceptorship programme for all nurses new to primary care to be piloted
A learning platform for “All Our Health” Learning Platform to be developed plus metrics to monitor the use of this resource
STPs to report on their primary care nursing workforce plans
A template induction programme for new practice nurses and HCSWs to be developed
The initial case studies showing the contribution of practice nurses to Leading Change, Adding Value to be published
Produce a GPN 10-point plan implementation update
Leading Change, Adding Value published by NHS England is a framework that demonstrates the nurse contribution to achieving the goals of the FYFV, and specifically in reducing the health and wellbeing, care and quality and funding and efficiency gaps:
General Practice Forward View, NHS England, Royal College of General Practitioners, Health Education England, April 2016
General Practice Nursing in the 21st Century: A Time of Opportunity, The Queen's Nursing Institute, January 2016
The General Practice Nursing Workforce Development Plan, Health Education England, March 2017
All Our Health: Personalised Care and Population Health, Public Health England, April 2015
District Nursing and General Practice Nursing Service Education and Career Framework, Health Education England, October 2015
For the online survey — www.england.nhs.uk
For the paper survey — www.webarchive.nationalarchives.gov.uk (Trust based)
Leading Change, Adding Value, NHS England, May 2016