Career advice

Why newly qualified nurses should not be put off working in general practice

COVID-19 vaccine delivery and a recruitment push will put practice nursing in the spotlight

From COVID-19 vaccine delivery to a national recruitment push, practice nursing will increasingly be in the spotlight

Improving pay and employment contracts is key to tackling the looming shortage of general practice nurses (GPNs), says the RCNs new professional lead for primary care.

There is a lot of inequity across the provision, with some GPNs getting very good terms and conditions, while others not so much, says Heather Randle, who took up her post at the end of September. Id like to see all these nurses feeling valued.

Not just pay, but training opportunities and feeling like part of the team

With around a third of all nurses due to retire in the next five years, the profession

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From COVID-19 vaccine delivery to a national recruitment push, practice nursing will increasingly be in the spotlight

A practice nurse in a consultation with a patient
Picture: Alamy

Improving pay and employment contracts is key to tackling the looming shortage of general practice nurses (GPNs), says the RCN’s new professional lead for primary care.

‘There is a lot of inequity across the provision, with some GPNs getting very good terms and conditions, while others not so much,’ says Heather Randle, who took up her post at the end of September. ‘I’d like to see all these nurses feeling valued.’

Not just pay, but training opportunities – and feeling like part of the team

With around a third of all nurses due to retire in the next five years, the profession overall faces a ticking timebomb – but the situation is even more critical in general practice nursing, where staff tend to be older.

‘We have an ageing workforce and an ageing population,’ says Ms Randle. ‘It’s particularly prevalent in primary care. We need to think about how we attract others into the role.’

Offering employment on the basis of Agenda for Change pay scales may help to lure those who currently work in the NHS and are used to this system, she believes.

‘But we also need to improve other terms, such as making sure these nurses get sick pay, are released for training and development, and feel a part of the team, being considered as equal members,’ says Ms Randle, who first joined the RCN two years ago, leading a project on medicines management.

Ensuring primary care nurses’ specialist skills are recognised

After qualifying in 1991, she worked in a hospital for 18 months before deciding it wasn’t for her. A local GP surgery offered her a post as a junior practice nurse, when this kind of role was just beginning, and she has remained working within primary care ever since, either full or part-time.

Heather Randle, RCN professional lead for primary care
Heather Randle: ‘My job is to champion general practice nurses’

‘It’s the place where I feel at home,’ says Ms Randle. ‘Although I’ve worked in lots of different roles, I’ve always kept a foot here. It’s my passion.’

Her lifelong experience gives her practical insight into what GPNs are experiencing on the ground. ‘I understand where nurses are coming from when they talk about what’s happening in their services,’ says Ms Randle.

‘I want to be the voice of nurses working in primary care, ensuring they are recognised for their specialist skills,’ she adds. ‘My job is to champion their roles, showing that general practice is a team effort and that GPNs are a big part of that team, leading in a variety of different areas, such as clinics and immunisation programmes.’

Lingering misperceptions about practice nursing

Although perceptions are gradually shifting, she says, an outdated view of general practice nursing as a ‘backwater’ still persists in some quarters. ‘A key aim is to raise the profile, so the public and other nurses understand what this role entails. I want to show the real value of it.

‘It’s a specialist generalist role and you need a wealth of skills, working with everyone from babies to older people’

Heather Randle, RCN professional lead for primary care

‘It’s very challenging and you need lots of skills, including understanding many different diseases. It’s really important people understand this more and I want to push it. I’d love to see some good news stories about the brilliant work that happens in general practice.’

Among the continuing challenges is boosting access to professional development. ‘A lot of the resources are for the NHS and we need them to be across the board, including the independent sector,’ says Ms Randle.

‘It would also be good to see more consistency, with GPNs being released for training rather than some having to do it in their own time.’

How to attract newly qualified nurses to general practice

Traditionally, few newly qualified nurses have considered a career as a GPN, or they have struggled to gain a foothold because of a perceived lack of experience.

‘We need to move on from this because it doesn’t need to happen,’ says Ms Randle. ‘We can have newly qualified staff in general practice and it would be great to see it more often.’

To help, she advocates a two-year fellowship for all nurses new to primary care – whatever their experience – similar to that already provided to new GPs. ‘It allows them to learn what they need to know in a supported way, with release from practice,’ explains Ms Randle.

Although this exists on a small scale in some areas, she would like to see it enlarged. ‘It should be available for anyone coming into general practice, as this is so different from working in a hospital,’ she adds. ‘It’s a specialist generalist role and you need a wealth of skills, working with everyone from babies to older people.’

While in the past, few nursing students would have had placements in GP surgeries, the figures are slowly rising. ‘If someone has worked in that environment and knows what it’s like, you’re more likely to entice them in once they’re qualified,’ says Ms Randle.

‘The NHS England ten-point plan is definitely helping on this, and we’re seeing increasing numbers. In NHS services, it’s the norm to always have students – that’s what needs to happen in general practice too.’

At a glance: the plan to boost general practice nursing

In 2017, NHS England launched an action plan to increase recruitment into general practice nursing and develop the roles of nurses working in this setting.

Its goals are to:

  • Raise the profile of general practice nursing, promoting it as a first destination career
  • Extend leadership and educator roles
  • Increase the number of student placements
  • Establish induction and preceptorship programmes
  • Improve access to return-to-practice programmes
  • Embed and deliver a radical upgrade in preventative medicine
  • Support access to educational programmes to deliver national priorities
  • Increase access to clinical academic careers and advanced clinical practice programmes, including advanced general practice roles
  • Develop career pathways for healthcare support workers, nursing apprentices and nursing associates
  • Improve retention

Working together through general practice networks

Primary care networks – made up of neighbouring general practices – provide even greater opportunities for students, Ms Randle believes. ‘It means nurses can work together to support these placements,’ she says. In practice, nursing students are able to work for a few different practices, in a hub and spoke model, gaining a breadth of different experiences.

Although she agrees that nursing associate and healthcare support worker roles should be expanded within general practice, there is a caveat. ‘We need to be sure they have robust support, so they are as effective as they can be, alongside clear definitions, including the accountability framework that goes with them,’ says Ms Randle.

‘They shouldn’t substitute for other roles, such as advanced practitioners or GPNs – we shouldn’t be using them instead of, but as well as.’

While Ms Randle believes it is too early to assess how well the ten-point plan may be working, it is moving the specialism in the right direction, she says. ‘Upskilling of the workforce and making sure that staff have the skills they need to be able to carry out their role is especially key.’

Leading the delivery of the COVID-19 vaccine programme

In the near future, GPNs will be at the forefront of the push to immunise the population against COVID-19.

‘They will be leading the delivery, training people in the wider workforce and administering the vaccine themselves,’ says Ms Randle.

On her personal wish list is improving job security for GPNs, alongside equity and parity with other colleagues working in this specialism. ‘They are autonomous practitioners and I want to see them more recognised,’ she says. ‘I’d also love to see increased recruitment. It’s a really good career – and getting that message across is so important.’

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