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Practice nurses harder to replace than GPs, says nurse in honours list

Practice nurses are now harder to replace than GPs due their growing expertise and status in primary care, according to a leading nurse.

Monica Fletcher, chief executive of Education for Health, said practice nursing should no longer be viewed as “just a career for part-time nurses”.

Nurses working in general practice settings are “more influential than they have ever been”, she said, highlighting the growing number of functions and roles they were taking on.

“If a nurse decides to leave to go somewhere else or retire, they take away a huge amount of expertise from the practice, which isn’t just as easily found as it might be to find yet another GP,” she said.

Practice nurses are also starting to “mirror GPs” by becoming knowledgeable across a range of long-term conditions, rather than specialising in one area, she told Nursing Times.

“Nurses are having to broaden out their expertise and their knowledge base to be able to work with patients with multiple long-term conditions,” she said. “I don’t think this role is going to get less complex, it’s going to get more and more complicated.”

Ms Fletcher spoke to Nursing Times last week following the announcement that she was to be made an OBE for services to nursing in the Queen’s birthday honours list.

She has led Education for Health, formerly known as the National Respiratory Training Centre, since 2001. The charity promotes education for practice nurses, especially in long-term conditions. 

Ms Fletcher, who is also chair of The European Lung Foundation, revealed that her “one big” concern was funding for nursing education.

“That’s a problem across the board, [but] I think practice nurses or nurses working within the general practice setting are in a difficult situation in that they are very much reliant on their employer,” she said.

“Ultimately they are employed by a GP practice, which should identify training budgets, but when push comes to shove and life gets tough – and there isn’t any backfill for the nurse perhaps when she isn’t there – it’s really hard.

“But it is important that nurses do receive their education,” she said, noting that more flexible ways of learning were now available through the internet.

“People want information pretty quickly these days and we can exploit that,” she said, noting that Education for Health had already developed a lot of online resources so nurses could take part in “bite-size” learning.

But Ms Fletcher insisted she did not the internet to become the only route to access training. “I think blended learning is great because people learn in different ways,” she said.

“Nurses benefit a lot from talking to each other. Our online learning is how we deliver information to them, but how many of them will learn is when they come away together on study days and they are with each other and can debate and discuss and apply that to practice. That’s really quite important.”

Asked whether practice nurses received enough training to be safe, Ms Fletcher said the situation varied geographically.

“It’s very patchy in some parts of the country, in other parts of the country it’s much better – like everything,” she said. “Patients will go and see a practice nurse and expect them to be clinically up to date and sometimes we don’t know what we don’t know.”

She identified use the technology as a potential gap in nurse education, especially around the sharing of information between patients and clinicians.

“Patients believe in what the healthcare professionals say and that’s very important, but they are also looking for more information elsewhere,” she said. “Being able to help people discern whether information is good or bad, or where it comes from, is a new skillset for nurses.”

“The nurse’s role is really changing. Being able to be a signposter, to help people through the myriad of information that’s out there is a whole new area really for nurses to be leading on.

“Their skills and their repertoire of skills are really changing, from not just being a good clinical manager of conditions. That means nurses themselves have to change in the way that they are thinking and approaching in the future.”

She noted that using popular websites for information gathering and research was not limited to patients.

“I was in a meeting recently and they were saying healthcare professionals, not just nurses, Google everything now,” she said. “It’s all there now at the end of your fingertips but how good is that [information]? – we must not be afraid of it, it’s out there, it’s another challenge.”

Ms Fletcher said she had felt “overwhelmed” on learning of her OBE, which she will collect at a ceremony later this year.

“I feel really privileged – it’s just amazing,” she said. “The first thing I did was look down the list for the other nurses.

“I’m overwhelmed by the number of people that have contacted me. It’s just amazing.”

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Readers' comments (4)

  • Sorry, but there is a very simple explanation for the difficulty in replacing Practice Nurses.......GPs only ever advertise for those with experience in Practice Nursing who possess specific certification in asthma, diabetes, etc. Unless and until GPs are prepared to invest in nurses who have valuable experience in other areas then this is only going to get worse. Broaden out your recruitment and you will gain a richer pool of skills, talent and qualifications.

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  • tinkerbell

    yes, good old 'Dr Google' as our consultant calls it.

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  • I agree we need to recruit more widely than ever before but GP's are generally not interested in investing time and money in training up new practice nurses preferring to try and poach more experienced staff. There is potentially a demographic time bomb due to explode as in some areas practice nurses are approaching retirement or looking to reduce their hours. More work is being pushed towards primary care teams, investment is needed to resource this, maybe central government need to address this.

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  • I have 25 years experience as a Practice Nurse – I work at an advanced level but do not have the qualifications to back up the role I do.

    I have repeatedly asked the GPs who employ me for further training to underpin the job I am doing – the answer is always ‘no’.

    I look for jobs at other GP practices to see if they would be prepared to put their ‘money where their mouth is’ and send me off to get my Minor Illness course and my Nurse Prescribers course – no joy there either, they want ‘ready made’ nurses who have all the qualifications they are looking for.

    I wonder where all these qualified nurses will come from ?

    I feel very vulnerable and anxious a lot of the time, I spend hours outside doctors doors waiting to pop in and ask them to sign a prescription based on my assessment of the patient.
    The doctors trust me to get it right; I am only human – although I endeavour to be very thorough and careful the chances are a mistake will happen.
    I wonder what will happen then?

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