Retirement and replacement – the double whammy for primary care

The Queen’s Nursing Institute has spelled out the main issues facing general practice nursing now – and among the most pressing is the workforce shortage.

Few working in primary care could be unaware of the problem – but the QNI has set out the scale of the shortfall in a report. It says 33% of general practice nurses (GPNs) are expecting to retire by 2020 and 43% do not feel their nursing team has the required number of appropriately qualified and trained staff to meet patients’ needs.

The practice nurse workforce is facing increased shortages but few working in primary care could be aware of the problem

Picture credit: Kate Stanworth

On top of that, a mere 27% of respondents said their employer offered placements to pre-registration nursing students. This is in stark contrast to the 61.5% who said their employer hosted placements for medical students.

General Practice Nursing in the 21st Century: A Time of Opportunity, is based on the results of a QNI survey of GPNs.

It collected the views of more than 3,000 GPNs working in the UK, covering areas such as workforce, education and employment.

QNI chief executive Crystal Oldman says the report is an opportunity for the collective voice of GPNs to be heard on issues important to them.

She said GPNs are under pressure: ‘Two thirds of practice nurses work unpaid overtime to ensure patients are seen. They are working longer hours to meet the challenge and changing jobs if another practice offers better terms and conditions.’

One scheme in the north of England is working to address the shortage of placements highlighted by the QNI report.

What the QNI survey tells us about practice nursing today

79% have considered preparation for NMC revalidation.

53% have employers who always support their professional development.

33% are independent prescribers.

66% said their employer provides their indemnity cover.

26% are an NMC-qualified mentor but more than half of these have not updated their qualification for more than three years.

The advanced training practice scheme run by Health Education Yorkshire and the Humber (HEYH) was set up to create placement opportunities for pre-registration nursing students.

Over the past five years, the training scheme has provided hundreds of placements. It uses general practice-based ‘educational hubs’ that help to recruit and support additional practices, which in turn offer placements.

More than 140 practices are now in the scheme, which is funded by HEYH and clinical commissioning groups.

Making progress

The placements are for six to 14 weeks and numbers have risen from 73 student placements in 2011 to almost 400 anticipated in 2016.

The scheme’s clinical lead, GP Peter Lane says: ‘Our target is 700 placements per year.

‘We have had excellent feedback, with the majority of students saying they would consider a career in general practice following their placements.

‘As the QNI report shows, there is a retirement risk across general practice nursing. In many areas of our region, a quarter or more of our highly skilled GPNs are over 55 years old.

‘Across the UK there needs to be a robust pipeline for replacing retiring nurses with newly qualified nurses, nurses wishing to move from other areas and those returning to practice after a career break.’

Dr Lane is working with HEYH to develop a region-wide accredited foundation programme for all new entrants to general practice nursing that incorporates a mentorship qualification.

He says that the lack of standardised terms and conditions across general practice means there is competition between practices. Employers have to outbid each other to attract experienced GPNs from the rapidly diminishing pool.

Dr Oldman says it is good to learn from models like that of HEYH but feels longer placements may be difficult to secure across all practices in the UK.

She says: ‘Another model that could give students a chance at getting a placement would be to offer pre-registration nursing students half a day or a day at a practice, and then a substantive placement in their third year with the view to moving into practice nursing when they qualify.’

Contrary to Dr Lane’s experience of a seller’s market, 65% of survey respondents said they did not feel their salary reflected their responsibilities. One clinical nurse lead, who mentors junior nurses, said her pay equates to £15 an hour, and does not reflect her skills. Others reported pay rates that range from £14.60 to £22 an hour. More than one quarter have two jobs.

Two thirds of GPNs are working unpaid overtime

– Crystal Oldman

In November last year, Health Education England published a district nursing and general practice nursing service education and career framework, setting out for the first time the specialist knowledge and skills needed for the professions.

Royal College of General Practitioners general practice foundation nursing group chair and advanced nurse practitioner Jenny Aston would like to see standardised nursing role descriptions across general practice based on the HEE framework.

‘This would go some way to working out pay scales for the role, but I believe it should be something different to the national NHS pay system Agenda for Change because GPs often do not want anything to do with AfC’.

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‘Put general practice on the radar’

Nurse director Julie Belton, who runs a general practice in west London with a fellow nurse, says she was shocked at the QNI’s finding that one third of GPNs are due to retire by 2020.

She joined the Cuckoo Lane Surgery in Hanwell four years ago to run it with Carol Sears, who took over the practice ten years ago.

Both directors attended the publication of the QNI report, and QNI chief executive Crystal Oldman has visited the surgery to learn more about their nurse-led model.

There are six nurse practitioners including the two directors, an additional three practice nurses and three GPs who work for four hours a day.

Ms Belton says: ‘It is important to have clear structures, terms and conditions, and a sense of uniformity.

‘I was shocked by the numbers of nurses retiring outlined in the QNI report and one solution is to make sure general practice is on the radar of pre-registration nursing students so they can be placed in general practice.

‘It is also important to retain the staff you have and the feedback I’ve had is staff want to be part of an inclusive team where nurses feel they have a voice.’

She says the practice invests in continuing professional development for its staff and developments in practice are shared among the team to help them to grow professionally.

Ms Belton adds: ‘We have a flat structure in our organisation and there is no real hierarchy. We have a short meeting of all staff at the start and end of each day where any issues are brought up, written down and emailed to all employees.

‘Constant communication is key. GPs and nurses have an open-door policy and are not embarrassed about asking for a second opinion. I would like to see many more models like ours across the UK so practice nurses are not working in isolation and are free to fulfill their potential.’

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