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Why general practice nurses must take ownership of what the new normal will mean

The pandemic has ushered in new ways of care delivery, many of which seem here to stay

The pandemic has ushered in new ways of care delivery, many of which seem here to stay

  • Many front-line staff believe there will no return to pre-pandemic methods of care delivery
  • It presents an opportunity to transform services, support innovation and develop technologies for the benefit of patients
  • Access to resources, education and skills provision is crucial as new roles or ways of working are developed

COVID-19 has transformed the way general practice and community services are delivered, and the consensus from those on the front line is that there will never be a return to pre-pandemic models of care delivery.

The term the new normal is now being

The pandemic has ushered in new ways of care delivery, many of which seem here to stay

  • Many front-line staff believe there will no return to pre-pandemic methods of care delivery
  • It presents an opportunity to transform services, support innovation and develop technologies for the benefit of patients
  • Access to resources, education and skills provision is crucial as new roles or ways of working are developed
Picture: iStock

COVID-19 has transformed the way general practice and community services are delivered, and the consensus from those on the front line is that there will never be a return to pre-pandemic models of care delivery.

The term ‘the new normal’ is now being used widely as we start to plan for a post-COVID future. This process has already started, as general practice begins the resumption of services, albeit in different forms. Therefore it is imperative that general practice nurses (GPNs) take ownership of what the new normal will mean to ensure their role is recognised and valued as new systems develop.

Over the past few months GPNs have demonstrated their flexibility and resilience by maintaining services as much as possible. They have also been swift to embrace different ways of working. The speedy move to virtual services has been prioritised, and GPNs have had to acquire the skills necessary to use these new technologies to deliver high-quality care in innovative ways. It has been a steep learning curve.

Shrinking nursing workforce in community settings

The GPN workforce was already in crisis before the pandemic. There were widespread nursing shortages in all areas and general practice was significantly challenged by high staff vacancies. Since September 2009 the nursing workforce in community settings has shrunk by 6.3%, despite an increased need for support in the community, an ageing population and more people with long-term health conditions.

Now, patients treated for COVID-19 and discharged into the community, and who may have multiple long-term conditions, will require ongoing nursing care, further increasing demand. In addition to the known effects of long-term ventilation, such as muscle wasting, evidence from studies in China demonstrates that COVID-19 survivors also live with the consequences of multiple organ failure, including renal and respiratory dysfunction, as well as delirium.

The next few months provide an opportunity to develop services in the community for those who require further treatment and rehabilitation.

Snippets from Facebook: general practice nurses on the ‘new normal’

‘General practice nurses (GPNs) have quickly adapted to enable them to continue to provide a service to their patients – rapid implementation of virtual consultations and use of technology while still seeing patients face to face for dressings, immunisation and support. An awesome bunch.’

For Facebook box

‘We’re using this horrendous time to make exciting changes. I’m so proud to be a GPN and to work in a dynamic, positive, forward-thinking team!’

‘We have adapted to doing remote consultations with very little, if any, training. We have adapted to helping in reception if and when required. We have been flexible with our hours to the benefit of the surgery and many have given up bank holidays to take the pressure off NHS111.’

‘We have pulled together to deliver high-quality care in very difficult circumstances, all while inundated with constant updates and emails.’

‘Things can’t go back to they way they were’

‘I love the new normal – encouraging patients to self-manage more and take more responsibility for their health.’

‘I miss seeing patients in the new normal.’

‘Our team all agree things can’t go back to the way they were.’

‘I am just waiting for the media to recognise who we are and what we contribute. I suspect I will wait a long time.’


Coupled with this we are also likely to see a continuing increase in mental health issues including post-traumatic stress disorder, psychosis, anxiety, depression and, in the most severe cases, suicide.

The extent of GPN involvement in managing patients rehabilitating after coronavirus is perhaps not yet fully known or acknowledged. But it is clear that GPNs need to be at the forefront to influence and shape services, and ensure quality of care is maintained. It is crucial that there is access to relevant resources, education and skills provision before any new roles or new ways of working are developed.

Most of us are looking forward to returning to some form of normality. But what do others think that normality will look like? I asked nurse leaders in primary care for their views.

Katy Smyth

Katy Smyth, lecturer at the University of Central Lancashire and a GPN, thinks the enforced modernisation and digitisation of services in primary care is here to stay, giving patients much greater choice in managing their long-term conditions and accessing healthcare.

‘The challenge is the current limited access to vital technology’

‘Using a range of apps, social media platforms and digital technology, GPNs are successfully navigating new ways of working with patients to undertake remote consultations and address healthcare needs,’ she says. ‘New initiatives such as online group consultations will become common practice rather than innovative.’

She adds: ‘I believe the challenge for GPNs is the current limited access to vital technology and equipment that would allow them to fully embrace the digital opportunities available. GPNs need equal access to up-to-date technology and relevant training in virtual consultations in line with their GP colleagues.

I believe GPNs are proving an invaluable source of support to their practice population across all age ranges, using their skills to ensure the health needs of their communities continue to be addressed.'

Expect a blended approach to learning with minimal face-to-face teaching

But the administrative burden associated with new ways of delivering services also needs to be factored in to GPNs’ workload, she suggests. ‘Managing email and online requests are already a large part of the administrative workload, and this is going to increase.’

And it is not only GPNs who are having to adapt, Ms Smyth says. ‘Within education we have started to look at how we can do things more digitally and provide new ways of teaching and learning. A blended approach to learning with minimal classroom based teaching will be the new normal.’

Ms Smyth says many GPNs currently studying in BSc or MSc programmes have been advised that they will not be released for training later in the year to continue studies.

Lack of GPN access to education will exacerbate the workforce crisis

‘I fear reluctance to allow GPNs to access educational opportunities will only exacerbate the workforce crisis by having a negative impact on recruitment and retention.’

She is also concerned that unmet patient need will increase because of COVID-19 restrictions.

‘This will be further compounded as we approach the yearly winter pressures. Organising and delivering this year’s flu season is a priority and will require a considerable amount of time and effort.’

Pandemic has transformed nursing

GPN Ann Gregory, a clinical nurse adviser for NHSX, which is NHS England’s digital health and social care transformation programme, says the pandemic has transformed nursing. ‘Our lives and those of our families, friends and colleagues will never be the same.’

Patients arrive by car at a primary care clinical assessment centre Picture: Getty Images

Some of her colleagues who have been shielding have been working from home and using remote technology to provide care for their patients. ‘They have learnt new digital skills to enable this change in practice,’ says Ms Gregory. ‘They’ve learnt remotely, without the usual training and support. It’s testament to their resilience and professionalism that they have coped and adapted.’

She is supporting her practice with its YouTube channel and encouraging GPN colleagues to record videos for the benefit of patients, such as how to test for blood sugar and how to use an inhaler and spacer.

‘We need to think about those colleagues who will be unable to see their patients face to face’

‘We need to re-evaluate and refresh’

Kathryn Yates, director of primary care nursing and workforce for Londonwide Local Medical Committees, urges general practice nurses to reflect on their journey so far during the pandemic and where it will lead

Kathryn Yates

‘Even though some things we do remain constant, I think we can all agree that there have been many significant changes to our ways of working. These range from how we manage and prioritise our own time and workloads to delivering care and supporting and engaging with our patients, colleagues and practice teams, often virtually.

‘The past few months have had a considerable impact on the personal and professional lives of all of us, with many now reflecting on what it was like “before” and where we are now, while also planning and preparing ourselves for what comes next.

‘During this time we have quickly developed greater confidence in normalising technologies that were new to many of us while recognising their benefits in supporting us in the care we give.

‘However, in times like these it’s important to pause and reflect on our own well-being and not to neglect our own needs. We must be proactive in seeking appropriate support where we recognise we need it.

‘Change, although challenging, can present opportunities. Therefore it is important to encourage ourselves to re-evaluate and, where necessary, refresh our recognition of our own knowledge, skills and expertise so we can articulate these to others. We must prioritise what matters to us, visualising where we want to be and how we are going to get there, and what we will need for the journey.’


Technology is also helping to maintain communication within teams and enabling GPNs to support colleagues who they are not currently seeing in person. ‘At least three of my nurse colleagues will not be present in the practice for some time,’ says Ms Gregory.

‘Their role as a GPN has changed. They will no longer take smears or undertake physical examinations, for example.’

She says GPNs are privileged to be able to develop long-standing relationships with patients of all ages, getting to know their families and their communities. ‘So we need to think about those colleagues who will be unable to see their patients face to face and how that will affect them.’

Angie Hack

‘To ensure best practice, an integrated approach must become mainstream’

Queen’s Nursing Institute (QNI) project manager Angie Hack identifies the new normal for primary, community and care home nursing as a continuum of the effective, evidence-based and integrated care strategies that have been employed during these unprecedented times.

‘Essential for the future is recognition of, and respect for, the specialist and unique characteristics of each nurse and their working environment, whether in primary care, the community or a care home environment,’ she says. ‘And to ensure best practice, an integrated approach must become mainstream for people provided with health and social care services in these contexts.’

‘An integrated approach ensures parity of best practice’

As a district nurse (DN) and GPN academic, her experience extends to working across all disciplines, including educating and supporting care home staff as a DN.

‘Sustaining an integrated approach strengthens local relationships, ensures parity of best practice and promotes equality of care for the public, wherever they reside,’ she says.

Ms Hack believes such an approach will not only improve communication and reduce the risk of inequalities in care but is an excellent opportunity to equip the public to take responsibility for their own health and well-being while maximising the expertise of nurses when their intervention is required.

But she says digital approaches to care are not right for all patients.

Early indications are that digital technology is highly effective for nurse-to-nurse education and support’

‘The success of digital consultation strategies means they will continue as mainstream, but nurses will need to be cautious not to assume that everyone has access to the necessary hardware and/or broadband connection, or the capacity to engage fully with this form of consultation.’

That said, she believes the early indications are that digital technology is highly effective for nurse-to-nurse education and support across primary and community nursing.

The new normal is also an excellent opportunity for GPNs to demonstrate their expertise in working with their communities, Ms Hack says.

Picture: iStock

‘The new normal offers a chance to educate and equip the public to self-manage’

She quotes Carol Webley-Brown, a Queen’s Nurse and senior GPN in Lewisham, London, who says the future for general practice post-COVID-19 is about ‘being creative in serving patients on so many more levels’, including using opportunities such as next-door neighbours helping out as volunteers when, for example, patients are discharged home from hospital.

‘The new normal offers a chance to articulate and draw on our specialist nursing expertise in population health to educate and equip the public to self-manage, but most importantly to prevent some of the old norms from creeping back in,’ says Ms Hack.

She highlights the significant role the QNI has played during the pandemic, listening to and supporting nurses working in primary care, community services and care homes, and offering online resources and emotional support through a new listening service.

Important to take stock and reflect on what has been learnt

I wish to thank my colleagues for their thoughtful insights. Currently, issues around healthcare are moving so fast it is becoming a challenge to keep up with new advice and guidance.

Consequently, it feels important to stop, take stock and reflect on what we have learnt, what we have gained and what we want to leave behind as we move on. This all looks pretty daunting, but the pandemic has given us the opportunity to transform our services, support innovation and develop the use of technologies for the benefit of our patients.


Picture of Marie Therese Massey
Marie Therese Massey

Marie Therese Massey, @MarieThereseRCN, is the RCN professional lead for general practice nursing

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