‘Shambolic’ practice nurse training leads to reliance on drug companies
Increasingly patchy funding for practice nurse training is encouraging “uneasy” alliances with the pharmaceutical industry, a Nursing Times investigation has revealed.
Practice nurses are often responsible for running vaccination programmes and smoking cessation clinics. Senior health figures have warned the reliance on drugs firms for training risks biasing clinical decisions and creating skills gaps in areas of low commercial interest.
There are potential risks and I don’t think we should be relying on the pharmaceutical industry for what should be mainstream education budgets
Queen’s Nursing Institute director Rosemary Cook said the motives of drug companies should be questioned.
She warned: “There could be a veil of naivety over this which says ‘because times are hard we will have to drop our standards or change what we do’.”
Nursing Times asked 100 primary care trusts how practice nurse training was funded, receiving 52 responses.
Only 15 had a dedicated, ringfenced, practice nurse education scheme, while the rest said training was the responsibility of GPs.
More than half said they were happy for the pharmaceutical industry to be involved, from paying for text books, conference travel and accommodation, to funding courses.
Some were forging more official alliances. NHS Liverpool is planning formal talks with pharmaceutical companies to see if they can suggest ways of meeting nurses’ learning requirements.
Head of quality for nursing Lynda Carey said the move was “a result of the times we are living in”.
Several strategic health authorities, including NHS North West, are also discussing joint working with the industry around patient care, education and training.
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NHS North West chief executive Mike Farrar said: “This isn’t about doing something cheap and nasty, it’s about trying to recognise that the two sectors can get mutual benefit from working together better.”
He added: “There are potential risks and I don’t think we should be relying on the pharmaceutical industry for what should be mainstream education budgets.”
Many nurses told Nursing Times that shortages in training funding were sparked by the recent division of PCTs’ commissioning and provider functions and were now intensifying due to the impact of public spending pressures.
While most PCT provider arms see it as GPs’ responsibility to provide training, the investigation showed some GPs were reluctant to pay for courses.
This is forcing nurses to seek commercial sponsorship or means they are paying for courses themselves to ensure they have the skills to work safely.
Royal College of GPs president Steve Field said GPs and PCTs should not shirk their obligations to provide appropriate training.
He warned pharmaceutical industry support and funding for training “could lead to undue bias which could affect prescribing”.
Ms Cook agreed, saying many people would be “uneasy” about training being funded by drug companies. She said there was a risk that nurses would miss out on training in clinical areas in which there is less of a commercial interest, such as sexual health or drug and alcohol abuse.
In PCT areas where funding is made available, the size of training budgets varies dramatically, from £25,000 in 2010-11 at NHS Bromley to £250,000 at NHS Leicestershire County and Rutland.
Royal College of Nursing primary care adviser Lynn Young called practice nurse education a “complete and utter shambles”, which requires a major rethink.
She said the financial climate was forcing nursing and the pharmaceutical industry into new relationships.
However, she added: “These are desperate times, but if we can form new relationships that benefit the profession and patients I have no problem with that.”
Only 18 of the 52 PCTs had a designated lead for practice nurse education.
NHS Plymouth practice nurse lead Tricia Smith said the role provided vital oversight of learning needs.
She said the lack of mandatory training meant practice nurses in some areas lacked core competencies such as ear syringing, immunisations and cytology.
Last year the Association of the British Pharmaceutical Industry released guidance on how companies should engage with the NHS on training.
The ABPI code, which regulates drug promotion, is operated by the Prescription Medicines Code of Practice Authority.
PMCPA head of communications Vicky Edgecombe said nurses should contact the regulator with any concerns.