Career advice

Mental health nursing in primary care: could you take an advanced role at a GP surgery?

Discover the advanced role that helps raise the profile of mental health services

Discover the advanced role that helps raise the profile of mental health services

Before joining the RCN as professional lead for mental health, I spent most of 2020 advancing career pathways for senior NHS nurses at band 7 and beyond.

An advanced career pathway that maintains clinical skills

The conventional career pathway for mental health nurses has aligned heavily towards management roles, reducing and sometimes removing the opportunity to develop as a clinician.

But in a survey exploring the career aspirations of mental health nurses across south London, carried out in February 2020, two thirds of the 235 mental health nurses who responded said they want to advance their nursing careers through an area of clinical practice.

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Discover the advanced role that helps raise the profile of mental health services

Mental health nursing in primary care
Picture: Jim Varney

Before joining the RCN as professional lead for mental health, I spent most of 2020 advancing career pathways for senior NHS nurses at band 7 and beyond.

An advanced career pathway that maintains clinical skills

The conventional career pathway for mental health nurses has aligned heavily towards management roles, reducing and sometimes removing the opportunity to develop as a clinician.

But in a survey exploring the career aspirations of mental health nurses across south London, carried out in February 2020, two thirds of the 235 mental health nurses who responded said they want to advance their nursing careers through an area of clinical practice.

Advanced practitioners in mental health can be pivotal in helping physical and mental health to be valued equally – improving the parity of esteem. In formulating a career development framework to support nurses embarking on a clinical pathway, advanced clinical practice became the central focus of my work.

Primary care seemed to be the obvious place to introduce these ‘new’ roles, but I struggled to find examples of how these roles have been successfully created, developed and fully embedded.

Then I met mental health nurse and Queen’s Nurse Jazz Kenney, who is leading the delivery of mental healthcare at Giffords Surgery in Melksham, Wiltshire. We had a conversation about her rewarding career as a mental health nurse in primary care.

Stephen Jones (SJ): Why did you choose this career pathway?

Jazz Kenney (JK): I have been working in primary care for about 12 years, and in my current practice for two and a half years. Before this, I was a shared care specialist nurse for substance misuse based in a GP surgery, but delivering secondary care. It was clear that patients preferred to be seen in the primary care environment, which is more anonymous for them. I developed a role with the partners of my previous practice, then did the same with my current practice, enabling patients with mental health issues to be seen by a practitioner who specialises in mental health.

SJ: What does the role involve?

JK: Every primary care service will have different requirements, depending on patient demographics and overall need. My appointments are laid out in the same way as for a GP or advanced nurse practitioner (ANP), but I specifically manage mental health presentations. These can range from mild anxiety and emotional distress to self-harm, first episode psychosis and suicidal thoughts.

‘Over the years, primary care settings have been employing specialists in diabetes, sexual health, respiratory illness and other physical health conditions. Mental health is just as important; without mental health input, you cannot provide holistic care’

Jazz Kenney, Queen’s Nurse

I work with patients of all ages, assessing and treating where appropriate and referring to secondary care if required. For most patients, their GP is their first port of call. If patients call the surgery with mental health concerns, they will be booked in directly with me whenever possible. My aim is to manage the cases holistically and consider all aspects of health to determine the best way forward for the patients.

SJ: Why is a role like this so important?

JK: This role is essential; it enables patients to access treatment and support in their GP practice as they do for all other health concerns. Over the years, primary care settings have been employing specialists in diabetes, sexual health, respiratory illness and other physical health conditions. Mental health is just as important; without mental health input, you cannot provide holistic care.

I have received some great feedback from patients, and there are positive reviews on the NHS website. A patient gave some excellent feedback last year, which helped in the process towards me being awarded the title of Queen’s Nurse. It is rare for this patient cohort to give feedback, so what I receive is much appreciated.

SJ: How is your role helping to change the provision of services in primary care?

JK: There are many mental health presentations that can be managed in primary care. It allows for physical and mental health to be treated in the same place and I have quick access to support and knowledge for any concerns I may have for the physical health of the patients. With pressure on secondary care services and the consistent reductions in what is available to patients, treatment by primary care clinicians is vital for patients and the future of mental healthcare.

SJ: Do you feel part of the primary care team?

JK: I am 100% part of the team. I am employed directly by the partnership and I’m lucky to work for such a forward-thinking practice, which listens to the team’s views and opinions, and recognises and encourages my passion for mental healthcare and parity of esteem.

SJ: How does your role support other members of the multidisciplinary team?

JK: My role supports the whole team, which works together to recognise and respect everyone’s different skills and abilities. I offer formal and informal supervision and advisory support to the rest of the nursing team, as well as providing practical teaching and pastoral support as required. I work closely with our nurses on chronic disease management and contraception, as both can have a significant effect on mental health.

SJ: What experience and qualifications do you need for a role like this?

JK: Nurses taking on this role need to have the confidence to work autonomously, and quick thinking and good assessment skills are a must. Time is limited in primary care, so interventions are brief. I am a non-medical prescriber but not all mental health nurses in the primary care environment need to be. As the role is still relatively new, it can be moulded to suit the individual needs of GP surgeries and mental health nurses.

SJ: Why should more mental health nurses take on this role?

JK: Mental health nurses have incredible skills, which are transferable to most environments. A good all-round knowledge of mental illness and how to manage and treat a variety of presentations is essential. Having a good generalist knowledge of the physical illnesses or disorders that can mimic mental health presentations, such as thyroid disorders or urinary tract infections, is also necessary, and helps to encourage parity of esteem.

SJ: What advice would you give to other nurses wanting to take up a post like this?

JK: Explore the options and go for it. The more of us there are in primary care, the more normal it will become. This will reduce stigma, encourage new and varied treatment approaches, reach more people and help with the ongoing improvements in parity of esteem. It is not an easy path, but it is a rewarding one – 12 years later and I am still here.

Why you should consider being a mental health nurse in primary care

  • The role is rewarding and completely different to the traditional hospital and community-based mental health nursing pathways
  • You will have many opportunities to change the provision of mental healthcare and promote parity of esteem
  • It will enable you to promote an integrated approach towards using holistic and evidence-based treatment for all healthcare needs
  • As the role is still relatively new, it can be moulded by you and the primary care provider to meet the specific needs of your local population
  • As the mental health specialist in a primary care environment, you will be an autonomous practitioner, which is empowering for you and those you work with
  • You will work with other highly skilled professionals, which will help expand your experiences and develop your knowledge and skills

Stephen Jones, RCN professional lead for mental healthStephen Jones, @SWJ_1, is RCN professional lead for mental health

Jazz Kenney, mental health clinical lead practitioner at Giffords Surgery in Melksham, Wiltshire, and a Queen’s Nurse Jazz Kenney is mental health clinical lead practitioner at Giffords Surgery in Melksham, Wiltshire, and a Queens Nurse

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