Analysis

Primary care and the workforce time bomb that must be defused

The existing shortage of practice and community nurses is only going to get worse in the next decade if there is not a boost to workforce numbers before a high proportion of clinicians retire.

With 64% of practice nurses aged over 50, and only 3% under 40, the Primary Care Workforce Commission has been looking at the future of this professional group. The commission was set up by Health Education England (HEE) at the request of health secretary Jeremy Hunt.

With more work being passed on from hospitals, practice nursing needs structure and support

In a report, the commission says nurses would more readily see primary care as a career if, like medicine, experience in primary care were included at all stages of training through pre and post-registration placements, and if a career pathway was more visible during training.

HEE produced an education and career framework last week setting out for the first time the specialist knowledge and skills needed to advance in practice and district nursing.

The framework will underpin the shift from acute to primary and community

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With 64% of practice nurses aged over 50, and only 3% under 40, the Primary Care Workforce Commission has been looking at the future of this professional group. The commission was set up by Health Education England (HEE) at the request of health secretary Jeremy Hunt.

With more work being passed on from hospitals, practice nursing needs structure and support

In a report, the commission says nurses would more readily see primary care as a career if, like medicine, experience in primary care were included at all stages of training through pre and post-registration placements, and if a career pathway was more visible during training.

HEE produced an education and career framework last week setting out for the first time the specialist knowledge and skills needed to advance in practice and district nursing.

The framework will underpin the shift from acute to primary and community care by defining standard roles and responsibilities, as well as providing practitioners with a clear career pathway.

Next month, the Queen’s Nursing Institute (QNI) is expected to publish the results of a comprehensive survey of practice nurses that will show that 34% of those working today will be retired by 2020.

QNI chief executive Crystal Oldman says: ‘As well as attracting experienced nurses, the general practice nursing service needs to become a first destination for newly qualified nurses, underpinned by an increase in the opportunities for placements and insights for nursing students to ensure primary care is visible as an exciting career prospect for the next generation of nurses.’

Practice nurse Jane Proctor (who retired last month) with healthcare assistant Danielle Seetaram

Picture credit: Nathan Clarke

The QNI will be publishing the results of its survey with a free online resource to support the transition of nurses into practice nursing. The resource can also be used to support revalidation.

Dr Oldman adds that the HEE career framework for practice nursing is an excellent step in increasing the visibility of the profession.

Some clinical commissioning groups (CCGs) are carrying out their own work to address workforce issues in their area.

NHS Liverpool CCG says it is looking at ways to tackle the number of practice nurses retiring after a survey suggested 80% were due to retire in two years.

NHS Leeds South and East CCG estimates 22% of its practice nurses are due to retire within the next five to ten years. The CCG is using a range of measures including a bespoke practice nurse course, commissioned with Leeds North CCG, and developed with Caritas Healthcare and Leeds University for nurses new to general practice.

Nurses on the NMC register with a general practice nursing qualification

October 2015 1,753

October 2014 1,772

October 2013 1,804

October 2012 1,816

Source: Nursing and Midwifery Council

A Leeds South and East CCG spokesperson says the course is expected to start in September 2016. She adds that to increase the number of practices offering training, the CCG has supported a scheme that enables nurses to become mentors. This has led to an increase in mentors available in practice to offer nursing student placements.

At the recent Best Practice in Nursing conference in Birmingham, Liberal Democrat peer Lord Willis, who chaired HEE’s Shape of Caring review, said there were no nursing students in official placements in general practice two years ago. Now there are 1,000.

A 2014 survey led by the Royal College of General Practitioners’ (RCGP) general practice foundation highlighted a lack of student placements, nurses with teaching qualifications and those attending mentor updates.

Extreme pressures

RCGP chair Maureen Baker says general practice is under pressure from all angles and this is affecting members’ practice teams – and patients.

Dr Baker says: ‘Practice nurses are an integral part of the general practice team – they are highly trained and greatly trusted by GPs and patients alike.

‘We need to implement initiatives to build the entire general practice workforce, including doing what we can to retain existing practice nurses while recruiting more to the profession, as well as thousands more GPs.’

Health Education Yorkshire and the Humber created an advanced training practice model to encourage the entry of nurses into general practice, providing nursing students with accredited placements.

Since the model was introduced, the percentage of nursing students considering practice nursing as a first career choice has increased from 30% before a GP placement to 88% after placement, with an increasing number of practices employing students directly on qualification.

Sheffield Hallam University director of placement learning Heidi Cheung is responsible for the South Yorkshire area, and says the university has been working closely with Health Education Yorkshire and Humber on the advanced training practice model.

She says potential practices are audited by the university to assess suitability for student placements.

‘We have 37 surgeries in South Yorkshire offering placements to students and that number has increased from ten student placements at any one time before this project to 42.’

RCN practice nurse association chair Marie-Therese Massey says that with a greater focus on primary care it is important to ‘bust the myth’ that nurses need to be experienced before they can work in general practice, and that it is vital to support nurses who want to move into the community with a transition model.

RCGP general practice foundation nursing group chair Jenny Aston adds that although there are pockets of excellence in addressing the issue of practice nurses who are retiring, these are not widespread. She says the group is working on a joint statement with the RCN about practice nursing recruitment and retention.

‘With an ageing population and increased work being passed on from hospitals, practice nursing needs proper investment, structure and support. It cannot only be about doctors – we need workforce support and money invested. It is not about doing this on a shoestring and we need clear nursing leadership’.

See letters pages 30/31

Many hospital staff want a change

Jane Proctor, pictured, who works at Sonning Common Health Centre in Berkshire, retired from her role as a practice nurse at the end of October after 25 years.

She says: ‘There are three nurses in the practice including me, and the other two are in their fifties. I will stay on for a little bit after I retire on a zero-hours contract so I can hand over to the nurse who is taking over from me.

‘She is in her fifties and was working in oncology and wanted to move from the hospital environment. I do not know what the quick solution is to filling the gaps when practice nurses retire, but I do know a lot of nurses working in hospitals are fed up and are looking at general practice as a career change.

‘It is hard for nursing students to get placements and difficult for them to put in the hours without getting paid for it.’

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