As the NHS celebrated its 70th birthday this summer there were plenty of nostalgic memories as we as we all reflected on how things were ‘back in the day’. The NHS has changed so dramatically since its inception in 1948 with technology and advances in medical science largely paving the way.
But the NHS landscape has also been shaped by those who use its services. We know that people are living longer with more complex conditions and this is reflected in the demand for services both in primary and secondary care.
It’s both an exciting and challenging time for those of you who work in a community setting. Whether in mental health, domiciliary, residential, adult or child services your role will be constantly evolving to try to balance the increasing demand with seemingly diminishing resources. And at the heart of it all is the GP Practice. Once known as the ‘family doctor’ the GP practice is now the gateway to all non-emergency services and is home to a multidisciplinary team of healthcare professionals including General Practice Nurses.
Following the 2016 General Practice Forward View (GPFV), NHS England produced a 10 point action plan for General Practice Nursing in 2017. This action plan is designed to provide a highly-skilled General Practice Nursing (GPN) workforce by:
As Ian Jones, Chief Operating Officer of the Practice Managers Association says ‘change is the only constant within primary care and that’s not a bad thing as we strive for continuous improvement. But there’s no doubt that keeping abreast of change is a continual challenge’.
Section 3 of Health Education England’s General Practice Nursing Workforce Development Plan – Recognise, Rethink and Reform recommends that:
We know that the changing role of GPNs has led to the need for you to have increased skills and knowledge to perform your role safely and competently. These skills are no longer purely clinical; increasingly the GPN role is one of leader, manager, safeguarder, educator and auditor.
Yet with your role expanding and demands on your time never lessening, how do you begin to keep up-to-date? We spoke to arrange of experts in the field, asking them what they saw as the main topics for GPNs to focus their learning on. We hope that you can use this information to direct your ongoing CPD and ultimately help you to feel confident that you are providing and managing an expert service.
Our experts all agreed that the management of long term conditions remains a cornerstone of General Practice Nursing. However, where asthma, COPD, heart disease and diabetes may once have been the ‘routine’ diseases that you came across, increasingly there is a need for you to develop skills in managing complex and multi-morbidities, frailty and supported self-management.
Yet of course the GPN skillset extends beyond the scope of helping those with existing illnesses. Your role requires you to be trained in a wide range of clinical skills including:
To be able to assess what your patient needs, you also need to have finely tuned clinical decision-making skills. We know that no two patients will present the same, many will a range of communication, learning and behavioural needs so you also need to have an adaptable approach.
Practice nurses are increasingly involved in wider roles within GP surgeries. You now need to be able to adopt a more business-like approach and effectively manage diverse caseloads. So, in addition to clinical skills you need to be proficient in the following non-clinical topics:
In addition, Linda Goldie, Clinical Director, Primary Care Training Centre, identified that some GPNs don’t seem to appreciate how research impacts upon the clinical guidelines that they follow. Linda said that ‘if they understood what underpinned the guidelines they may be more appreciative of why, for example, targets are driven.’
Other areas where our experts felt more attention could be given include:
Unfortunately, we don’t have a crystal ball so it’s impossible to predict exactly what’s in store for GPNs. However, we do know that demands on services will only increase as more care is being provided by primary care.
On an individual level, it’s likely that your case load will get even more complex and the list of skills that you need to maintain competence in will get longer. On top of the core values, skills and competencies identified in the General Practice Nursing Service Education and Career Framework (Table 1) you will also have to embrace changing and expanding clinical needs (e.g. long-term conditions, dementia, mental health, health promotion etc) as well as non-clinical needs such as mentoring, leadership, resource management, clinical decision making etc.
Table 1: GPN Skills and Competencies
On a wider level, for the GPN profession one of the most pressing issues is the volume of nurses approaching retirement in the next few years: in fact, the Queen’s Nursing Institute (QNI) survey revealed that over a third of GPNs are due to retire by the end of 2020.
In his article ‘Trends in practice nursing for 2019’ Ian Jones highlights the plans laid out in the GPFV to increase all members of the General Practice workforce including specific investment ‘earmarked for enhanced retention schemes to help keep the existing nursing workforce and to support a return to work scheme for GPNs.’
In order to increase retention / attract more nurses into the profession it seems that there needs to be clear strategies to help educate and support GPNs at every stage in their career.
NHS England’s Ten point action plan for General Practice Nursing (2017) and Health Education England (HEE)’s General Practice Nursing Workforce Development Plan – Recognise, Rethink and Reform (2017) both expand on the District Nursing and General practice Nursing Education and Career Framework (HEE 2015). It is hoped that these plans and frameworks will help set out a career pathway and improve access to training, skills development, leadership opportunities and professional support.
In addition to supporting frontline practitioners and increasing workforce retention Julia Neal, Director of Education, Education for Health also believes that ‘we need to do far more to make sure General Practice Nursing is recognised for what it is, and that people recognise the growing importance of the role.’
GPNs play such a pivotal role with the community, we need the workforce to feel energised, motivated and respected. So, let’s hope that the next few years sees increased funding, resources and opportunities for GPNs across the country.
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