Comment

Practice nursing will receive welcome boost from new strategy

Many are hailing it as the most significant development since the 1960s. NHS England’s General Practice Forward View is a vindication of our call for more investment in primary care nursing.

Many are hailing it as the most significant development since the 1960s. NHS England’s General Practice Forward View is a vindication of our call for more investment in primary care nursing.

Primary care is to receive a £2.4 billion recurrent investment in general practice; a £500 million sustainability package; redesigning of services and support for collaborative work; a reduction in workload and bureaucracy; more staff and a pledge to reduce the regulatory burden of the Care Quality Commission.

The Queen’s Nursing Institute 2015 report on general practice nursing revealed one third of the profession is due to retire within the next five years, but the future of nursing is in the community. We in primary care feel undervalued and misunderstood. Our roles are rich, diverse and satisfying and we want others to join us.

For general practice nursing, NHS England and Health Education England (HEE) will invest £15 million to improve training capacity, increase the number of pre-registration nurse placements, put in place measures to improve retention of staff and support a return to work scheme for general practice nurses.

But we may have a bit of a chicken-and-egg situation. Primary care is buckling under demand. Training nurses in transition or supporting students is a big ask. We must ensure GP workforce and bureaucracy issues are addressed urgently. Many nurses are hanging on, post-retirement, waiting for the cavalry to arrive. So, alongside GP recruitment, let’s accelerate the transition of secondary care nurses into primary care before throwing students into the mix.

We need to address our whole culture – where secondary care is seen as a necessary skill to be ‘done’ before moving to primary care. We must challenge those universities and trusts which might place this idea in the minds of nurses. ‘Acute’ nursing care exists in the community. Complexity is increasing. It isn’t a competition – we just want a level playing field.

I am always perplexed that each HEE region seems to reinvent the wheel on practice nurse developments. It would never be allowed for GPs. HEE should take best practice and develop a gold standard for practice nurse education, with speedier delivery.

Practice nurses won’t be on their own. The primary care skill mix will diversify to include 1,000 physician associates, specialist pharmacists, mental health workers, social workers, physiotherapists and the voluntary sector. It’s heartening to see the focus on mental wellbeing and the social determinants of health. But we need to keep an eye on the role and function of the practice nurse, assistant practitioner and advanced practitioner to ensure these roles are not diluted.

Having recently been seen in the emergency department by about six people – only one of whom introduced herself (the healthcare assistant) – we have to ensure we don’t build a factory of primary care and lose our humanity. Primary care needs to keep relationships with patients and families.

My fear is nurse leaders will repeat the mistakes of their predecessors and see the development of the practice nursing workforce as a nursing issue. It’s not: it’s a system issue.

Employers must understand the value of nursing and we must appreciate the economic return on investment in us.

We must engage the whole system and move from a clinical focus to a social and economic one. Health care is only 10% of health. Primary care without boundaries should be the aim.

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