Too few primary care nurses with leadership roles involved in service delivery decisions

Nurses’ Voice network seeks to help primary care nurses develop their careers

Nurses’ Voice network seeks to help primary care nurses develop their careers

Picture: iStock

Too little ‘clear, visible’ nursing leadership is threatening nurses’ future in primary care, argues one nurse working to improve nursing provision in the community.

Joanne Loades

Independent nurse consultant and specialist in cardiovascular disease Joanne Loades is at the helm of a new national network working to raise the profile of primary care nursing.

Along with colleague Michaela Nuttall, Ms Loades is helping to lead on the Nurses’ Voice network, a new project funded by the National Association of Primary Care (NAPC).

This project aims to improve the voice of nurses working across primary care in key policy making, and to develop and monitor action after the publication of national documents.

‘Primary care nurses we have spoken to feel that nurses don’t have a seat at the table when it comes to decision making,’ explains Ms Loades.

Nurses’ input

‘This is important because nurses are a valuable part of primary care teams and the profession is changing at a pace with many different organisations emerging,’ she adds.

‘But where is nurses’ input on design and decision making in these new ways of delivering care?


nurses work in general practice in England

Source: NHS Digital 2018

‘And what does the future hold for nurses if they are not involved in that decision making?’

Ms Loades is well aware of new integrated models of care and how nurses can influence the healthcare agenda.

She works for one of NAPC’s own designed and developed primary care home (PCH) test sites, launched in 2015 by NHS England chief executive Simon Stevens.

Population needs

The PCH model brings together a range of health and social care professionals who provide enhanced personalised and preventative care for their local communities.

Staff are drawn from GP surgeries, community, mental health and acute trusts, social care services and the voluntary sector to focus on local population needs and provide care closer to patients’ homes.

The PCH model is featured in the Next Steps on the NHS Five Year Forward View and is part of NHS England’s plans to transform primary care over the next two years.

‘Our aim is to improve the voice of nurses working within these new emerging health systems, get people sat at the table, rather than being at the back, and improve leadership,’ Ms Loades says.

She intends that the Nurses’ Voice network is involved in the NHS England ten-point action plan for general practice nursing.

‘We want to identify nurse leaders who can offer an expert panel for the ten-point plan in the regional delivery boards,’ she says.


One of the first challenges Ms Loades and Ms Nuttall encountered was finding enough general practice nurses in leadership positions to consult.

‘We went to RCN congress in Belfast this year but found few nurses working in primary care, and only eight who were in leadership positions.


of district nurses left practice over the past eight years

Source: Queen’s Nursing Institute 2018

‘We asked if they would join us for a focus group to talk about their experiences and where they saw the gaps.’

According to Ms Loades, who also met with the RCN general practice nursing forum, the nurses think there is little clear and visible nursing leadership for primary care.

They also reported there is no seat at the table for decision making in primary care and that support for nurses develop leadership skills is often inaccessible.

Leadership roles

Following this, she and Ms Nuttall surveyed primary care nurse leaders about their roles, receiving 330 responses from staff including general practice and district nurses, and community matrons.

Michaela Nuttall

‘The survey shows us is there is little consistency in how nurses are employed, where they work and who they report to,’ explains Ms Loades.

However, the survey also suggested that nurses working as part of the new PCH sites perceive they have more agency in their roles.

Asked whether they consider themselves leaders at work, 63% of nurses working in PCH sites said they do, compared with 50% of those working elsewhere.

In addition, of 27 nurses who were working in PCH sites, 100% were ‘very happy’ with clinical supervision, compared with 29% of the 88 nurses who were working outside PCHs.

Nurse-led projects

Ms Loades says she and Ms Nuttall are looking for more nurses to complete the survey and invites readers to contact her.

‘We would like to expand the numbers of nurses who have completed our survey.


of nurses working in primary care home sites think they are leaders

Source: National Association of Primary Care 2018

‘If there are any good nurse-led projects going on in primary care, we would like to hear about them.

‘We are looking for strong examples of nursing leadership and resources.

‘We want to provide case studies and examples of where nursing leadership is adding value in primary care.’

Ms Loades says this is an important moment for nurses in primary care to influence the agenda.

‘How can we attract nurses to come and work in primary care if this is an area where nurses feel they become disempowered?

‘Now is the time, while change is going on, to make sure we have a seat at the table.’

Contact Joanne Loades at with case studies or to take part in the Nurses’ Voice survey

Survey results

Nurses working in primary care homes (PCHs) may have more accurate job descriptions, better access to clinical supervision and feel more like leaders in their role, according to a survey.

Responses from 330 nurses shows they have greater satisfaction from working in PCH sites than nurses in other areas who were surveyed by the National Association of Primary Care.

One example in which nurses work in a new way can be found at South Durham Health Community Interest Company PCH site.

The area has high levels of adult male suicide, diabetes and social deprivation, and unemployment and disability claims are widespread.

To address the high suicide rates and reduce delays in accessing treatment, community psychiatric nurses have been based in GP practices so patients with mental health needs can be directed to them immediately.

In Cambridge, at the Granta and Shelford PCH, there are plans to pilot the acclaimed nurse-led Buurtzorg model of community nursing, from the Netherlands.

The model empowers nurses to deliver all the care that patients need while encouraging them to maintain independence for as long as possible.


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