Practice nursing: an action plan for a disparate workforce
NHS England has published a ten-point plan to raise the profile of general practice nursing and make it easier for practices to recruit and retain nurses.
NHS England has published a ten-point plan to raise the profile of general practice nursing and make it easier for practices to recruit and retain nurses
A third of general practice nurses are preparing to retire within the next three years, leaving the workforce facing a major crisis. In response, NHS England has published a ten-point action plan to develop general practice nursing and boost numbers.
To improve recruitment and retention it pledges to increase the number of student placements in general practices, encourage more newly qualified nurses to go straight into primary care, and entice back previous registrants through return-to-practice courses.
Establishing inductions, preceptorship, clinical supervision and better access to education are also covered in the document, called General Practice – Developing confidence, capability and capacity.
New roles, such as nursing associate, will also be introduced under the plan, which is backed by £15 million of funding.
Fit for the future
NHS England and nursing leaders agree that swift action is needed. A Queen’s Nursing Institute (QNI) survey of more than 3,400 general practice nurses last year found that 33% were planning to retire by 2020. Four out of ten said their team already had insufficient staff.
Writing in the foreword to the action plan, England’s chief nursing officer Jane Cummings says that general practices ‘face very considerable challenges recruiting and retaining a workforce that is fit for the future’.
RCN professional lead for primary and community care Kathryn Yates says improving awareness about the work of practice nurses is an important part of the plan. ‘It’s time to raise the profile of primary care,’ she says.
‘Nurses are busy people working in quite stretched practices - whatever the system can do to help them is important’
Four regional general practice nurse delivery boards are being established around the country to deliver the plan. Among their first jobs is to find out how many general practice nurses there are and how many placements are available for students. These placements are expected to increase by at least 15% next year and 20% the year after, so more undergraduates will be exposed to practice nursing.
By January 2018, NHS England and Health Education England (HEE) will establish a target for the number of additional practice nurses to be employed.
QNI chief executive Crystal Oldman welcomes the plan, and says the institute’s advice has generally been included in the approach. ‘It is forward-focused and published at the right time,’ she says.
Hard to reach
But there are aspects of practice nursing – a disparate, hard-to-reach workforce employed by 8,000 GP practices – that will make some aspects more difficult to deliver, she says.
One problem with increasing placement availability is indemnity insurance; some practices have been told that students won’t be covered by their insurance. It is an issue needs to be addressed nationally, Dr Oldman says, because it is scuppering placements that practices are willing to provide.
Small practices with few nurses often struggle to provide placements and adequate support for a newly qualified nurse. Practices joining together into hubs or federations can help overcome some of these difficulties, she says. ‘Delivery of the plan is really by the nurses, who are busy people working in quite stretched practices. Whatever the system can do to help them will be really important.’
‘Practice nursing is an exciting career pathway and if students are exposed to that they are much more likely to want to come back when they are qualified’
Queen’s nurse Debbie Brown, a nurse consultant in primary care in Lewisham, welcomes the action plan’s focus on increasing placements and encouraging nurses to begin their careers in general practice. In Lewisham, as in many areas, recruiting experienced practice nurses has been difficult.
But over the past two years, five students have carried out their final placements at her practice and a nearby practice, and three of them have been recruited as local practice nurses and one as a district nurse. The area has also recruited nurses from other clinical areas recently, such as mental health and intensive care, bringing useful new skills into the practice.
‘Practice nursing is an exciting career pathway and if students are exposed to that they are much more likely to want to come back when they are qualified,’ Ms Brown says.
She says that many practices are put off offering placements because they have never had students, and by misconceptions such as that a student would need their own room and take up a lot of the practice nurses’ time. While placements do require time, particularly if the student is in their third year and on their final placement, Ms Brown says she also learns a lot from the students.
She urges HEE and NHS England to invest in mentorship training for practice nurses and improve the £70-a-week payment that practices receive for a student on placement, which is insufficient to cover the cost of supporting a student. It needs to be double that amount, particularly for those in their third year who need the most intensive support, she says.
‘Once surgeries become used to having students and see the value they can bring, such as a wealth of up-to-date knowledge, they will see we can grow our workforce for the future,’ says Ms Brown. ‘We are sharing our skills and expertise with them.’
Building a workforce in East Staffordshire
Some practices in East Staffordshire have been successfully producing their own workforce for a number of years.
Queen’s nurse and primary care facilitator Gill Boast, professional lead for practice nursing at NHS East Staffordshire Clinical Commissioning Group, says nursing students have been welcomed on placements in the area for 12 years. Initially two practices offered placements, but recently this has started to increase.
Rapport with patients
‘We have had third-year students who have chosen to come into practice nursing on qualification, and some who go into secondary care for a couple of years and then come back,’ she says. ‘Newly qualified and inexperienced nurses are now able to undertake the Fundamentals of General Practice Nursing course, which equips them with knowledge and skills for the role.’
Louise Goodyear, now a junior practice nurse in Burton upon Trent, returned to the practice as a newly qualified nurse after undertaking a placement there in her final year of training. ‘I have had a lot of support here from a fantastic team,’ she says. ‘It is a wonderful career and I look forward to going to work so much. You see the patients again and again and get a nice rapport with them and really feel you can make a difference to their health.’
Practice nurse Karen Reid had to work for two years post-qualification at the hospital which supported her in taking her nursing diploma. But from the first week of a second-year placement in general practice she knew that was the career she wanted and chose to go back there for an elective placement in her third year.
She snapped up a place at the practice for someone without experience, trained at work and has also just completed her mentorship training. ‘Sometimes people seem to think that practice nurses are older, ready to retire and it could be a bit boring. But we have a mix of ages within our team, everyone is motivated and it is a really exciting job.’
The ten-point action plan
- Celebrate and raise the profile of general practice nursing and promote it as a first destination career.
- Extend leadership and educator roles.
- Increase the number of pre-registration placements in general practice.
- Establish inductions and preceptorships.
- Improve access to return-to-practice programmes.
- Embed and deliver a radical upgrade in prevention.
- Support access to educational programmes to deliver national priorities as set out in the Five Year Forward View.
- Increase access to clinical academic careers and advanced clinical practice programmes.
- Develop healthcare support worker (HCSW), apprenticeship and nursing associate career pathways.
- Improve retention.
Erin Dean is a freelance journalist