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A career ladder that general practice nurses can climb

New leadership and training opportunities are opening up for primary care nurses

New leadership and training opportunities are opening up for primary care nurses


Picture: iStock

In July 2019, general practices nationwide were required to join primary care networks (PCN).

PCNs were developed nationally as part of the NHS Long Term Plan and are based on general practice registered lists.

PCNs serve communities of 30,000 to 50,000 and enable groups of practices to work together to provide better access and services for patients.

PCNs are offering leadership opportunities and nurses are stepping up to the challenge

Each PCN is led by a clinical director and this new way of working is opening up leadership opportunities for primary care nurses.

‘The General Practice Nursing Ten Point Action Plan is a £15 million investment from the General Practice Forward View to develop nursing in general practice, and one of the key components is around leadership development,’ says NHS England primary care nursing lead Karen Storey. ‘As the dynamics and the profile of general practice nursing are changing, nurses are stepping up to the challenge and taking on those leadership roles.

‘As one of the first nurses to take on the role nationally, I was adamant that I should be seen as an equal’

Carole Phillips, advanced nurse practitioner and joint clinical director at Brunel Healthcare PCN, Portsmouth

‘We now have 13 nurse clinical directors of PCNs. Although any member of the primary care team – GP, practice nurse or allied health professional –  could be a clinical director, the expectation was that most would be GPs. So to see nurses in these roles is fabulous. It is almost like an executive level of leadership within general practice nursing that we’ve never had before.'

Working together to improve care in Portsmouth

Carole Phillips is an advanced nurse practitioner and joint clinical director at Brunel Healthcare PCN in Portsmouth. Her PCN is one of the biggest in the country and has a diverse patient population of 79,000.

Carole Phillips is joint clinical director at Brunel Healthcare PCN in Portsmouth
Carole Phillips

The nursing team at the university surgery where Ms Phillips is based has expertise in sexual health and contraception. At the other side of the city, 70% of patients are over 70  and the nursing team is skilled in end of life care.

By working together, Ms Phillips hopes to use this combined workforce to reduce waiting times for appointments across the city and to free up nurses to focus on more complex care.

‘As it’s such a big PCN, we have two clinical directors and my counterpart is a GP partner,’ says Ms Phillips. ‘I’ve been working as a nurse in general practice for almost 30 years and I have governance, assurance and quality knowledge. 

‘I didn’t apply for the PCN job, I was asked to take it because they needed a nurse or allied health professional. My experience fits well and I was privileged to be asked to do it.

‘As one of the first nurses to take on the role nationally, I was adamant that I should be seen as an equal. I would like to achieve cross-network working for all nurses and carers within the city, regardless of who pays their wages. We need to talk to each other more.’

A chance for general practice nurses' voices to be heard

Bernadette Millwood is co-clinical director of Icknield PCN in Hertfordshire
Bernadette Millwood

Bernadette Millwood is a senior general practice nurse, primary care nurse tutor and co-clinical director of Icknield PCN in Hertfordshire.

‘It was a surprise to be offered the role but it’s great for practice nurses. We do have a voice and it has not been heard up until now,’ says Ms Millwood.

‘I was chosen for the role because I know everyone in our locality due to my tutor role. I also run practice nurse forums at the surgery and I work at NHS East and North Hertfordshire Clinical Commissioning Group (CCG) once a week.

‘I feel we have to take the pressure off GPs by providing other services and that’s where pharmacists will come in. It’s about creating slicker services’

Bernadette Millwood, primary care nurse tutor and co-clinical director, Icknield PCN, Hertfordshire

‘I’m job-sharing with a GP in my clinical director role and although we have different skill sets, it seems to be working well. We have set up a WhatsApp group and we communicate regularly and that's going to be key.

‘It’s a lot of work but it’s exciting and we want to provide good care for our local community. We have an elderly patient population and several care homes. Within our practice, we have four GPs and they each spend a whole morning or afternoon at a care home. It’s a huge amount of GP time and it has a knock-on effect in terms of what we can offer at the surgery.

‘I feel we have to take the pressure off GPs by providing other services and that’s where pharmacists will come in. It’s about creating slicker services.’

Nurse clinical directors are part of a big milestone in GP nursing

Andrea Mann is clinical director at Crossgates PCN in Leeds
Andrea Mann

Andrea Mann is a general practice nurse and has been managing partner at Colton Mill and The Grange Medical Centre for four years. Last month, she began working as clinical director at Crossgates PCN in Leeds. The PCN has a patient population of 34,000 and Ms Mann works with two clinical directors from nearby Seacroft and York Road PCNs. 

‘I’m the only nurse clinical director in Leeds. There are 19 clinical directors and 18 are GPs. I’ve formed a network with ten other nurse clinical directors nationally.

‘We want to raise our profile to encourage more nurses working in primary care to consider this as a potential role for them to move into.’

Ms Mann was chosen for the role as a result of working as head of nursing for quality and governance at NHS Leeds CCG and across Leeds GP Confederation.

‘We want to raise our profile to encourage more nurses working in primary care to consider this as a potential role for them to move into’

Andrea Mann, general practice nurse and managing partner at Colton Mill and The Grange Medical Centre

‘Several clinical leaders within our patch supported me to apply for the clinical director role. Had I not been in my CCG role, it might have been different without that exposure outside of practice and not having those networks and relationships that I’ve built up on a citywide level.

‘That’s what we need to increase. Not all practice nurses need to go into clinical director roles but we need to encourage nurses to work at different leadership levels across primary care. As nurse clinical directors we are part of a big milestone in general practice nursing. It’s an exciting time.’

The Queen’s Nursing Institute (QNI) has announced it is opening up a new leadership programme for PCN clinical directors. The programme is a combination of residential and study days over a six-month period. More information can be found via the QNI’s website. The deadline for applications is 1 September 2019.

Preparing the next generation

As part of NHS England’s aim to increase opportunities for leadership development in primary care, a bespoke training programme has been created.

The NHS Leadership Academy has adapted its Rosalind Franklin Programme for nurses working in general practice and primary care. The ten-month programme also includes psychotherapeutic development elements from ShinyMind.

There are 28 participants on the current programme, which started in May.

Charlotte Cooley is an advanced nurse practitioner at Hampstead Group Practice and lead nurse for Islington GP Federation, as well as governing body GPN for Camden CCG. She is participating in the programme.

Charlotte Cooley is on the training programme for leadership development
Charlotte Cooley

‘It feels like a special opportunity as we’re usually a lone voice in our different areas so to have a cohort that is all practice nurses is unique,’ says Ms Cooley. ‘As a nurse, to have this level of personal development that isn’t clinically focused feels like a treat. You have time to sit back and think what am I like as a leader and it enables us to put aside imposter syndrome.

‘I’ve been a GPN for 20 years and what I bring to the table is valid and important. There’s a sense of anticipation around where the programme may lead. I feel there’s still work to be done to increase leadership opportunities as we don’t get invited to the table a lot of the time and we’re not always included in those conversations.’

Helen Crowther is a clinical nurse adviser at North Tyneside CCG and part of the primary care digital transformation team at NHS X. She too is a participant in the programme. 

Helen Crowther is on the training programme for leadership development
Helen Crowther

‘I’ve been qualified as a nurse for 20 years and we’ve never had anything like this within our training or had opportunities that have been specifically for practice nurses,’ she says. ‘The 28 of us have created a big network. The programme content encourages self belief and greater self awareness and the ShinyMind components have been very helpful. 

‘Everything is geared towards giving nurses working in primary care a career ladder that we can actually climb. It’s making such a big difference for everyone  on the programme. The self-reflection the programme asks you to do makes you consider where is next and what you can do. We’re in a good place in terms of the opportunities that are open to us now.’

Ms Storey feels there is an issue with practice nurses not recognising the valuable skills and experiences they have. ‘When I ask whether they would consider themselves as a leader, many nurses would say no even though they’re making great things happen in practice. All nurses are leaders and we are capable of influencing change.’

The Rosalind Franklin Programme will return in November 2019 with a new cohort of 32 participants. Applications can be made via the NHS England GPN Single Point website

 

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