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‘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.

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.

Readers' comments (15)

  • CandyEFH

    Sensational headlines like this one are undoubtedly eye catching but the issue of who should be responsible for funding practice nurse education is not a new one. However Education for Health’s experience, over nearly 25 years, is that benefits of high quality educational initiatives can be maximised with highly effective partnerships with industry.

    Chief Executive of NHS North West SHA Mike Farrar is to be congratulated on his willingness to speak out for the opportunities which could be realised if the NHS and industry developed “carefully designed solutions….to work in partnership to regenerate the economy and deliver benefits to patients and tax payers” (Pharmaceutical Field May 2010).

    As NHS funds tighten there’s a certain inevitability that education budgets will disappear once again. And whilst this is unlikely to be the only inflammatory headline Education for Health has long term plans in place to partner with our industry colleagues on high quality initiatives designed to improve patient care.

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  • I run a practice nurse course and out of the 8 students that started only 3 completed. Not only is it difficult for nurses to get the training but when they do often circumstances change (no job) GPs are reluctant to release them or they cannot find an appropriate mentor as no one has done the training and can be recognised as competent. Nothing has changed in the last 20 years then since I started practice nursing!!

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  • Lynnie

    Oh how awful - drug companies paying for nurse training ! What next ....
    What a load of tosh - they've been doing this for years - back in the 1980's they sponsored my asthma diploma course, and have supported many of the hundreds of study days that I've been on over the past 20 years.
    I'm not saying that there shouldn’t be money from PCT's and G.P surgeries (who by the way had this taken into account when their global sum was agreed so should already have money in the budget) but this is not news. Yes of course they are trying to sell their wares - so what ! Do you think we have no integrity or common sense? We know the score and the pharmaceutical companies mostly have a budget for training and I would rather they do that than spend the money on leaflets or other promotional materials. They provide a valuable service - getting sometimes international speakers to meeting and providing venues, refreshments and support materials for nurses all over the country. They have been the only consistent resource for practice nurses over the years and I for one would like to thank them for that.
    In the current economic climate I hope they step in and do more because I can’t see anyone else wanting to.
    As for those area's with "less commercial interest" that the pharmaceutical companies dont support - maybe thats where the PCT or GP's surgery should put their hands in their pockets?

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  • Nurse education is a complete and utter shambles it's hardly cricket to accept that Big Pharma should fitting the bill when GP's are making such fat profits from having practice nurses do all the boring stuff that they don't want to be bothered with. Shame on PCT's that allow them to wriggle out of their responsibility - tax deductable no doubt - to the patients and the staff.

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  • Some of the pharaceutical drugs really help people but there are a lot that don't also it is a HUGE money making industry and this is what's worrying.
    If the pharm industry are paying for our courses then will be learning what drugs they think will sell best...

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  • Well said Lynnie!! I agree totally with your comments. I have been practice nursing for the past 20 years and to be honest if the pharma companies had not been around to sponsor training, courses, conferences etc etc. practice nurses would not be as educated as they are today. No organisation wants to take responsibility for practice nurse training. GP's won't foot the bill as they worry about paying for training and the nurse then moving to another post elsewhere. They see that as money down the drain. On the subject of practice nurse training, it would be interesting to know how many nurses are training currently to fill the shoes of the ageing practice nurse workforce. Certainly in my area, I know of not one trainee in post. Considering a large proportion of the practice nurses currently working in this part of the country are well into their 40's and 50's I would think it is a topic that needs discussing at higher levels. We hear constantly of the push to provide ever increasing services in the primary care setting. Who will be doing this in 10yrs time? I think GP's think there is an inexhaustible supply of nurses with the skills to meet the demands of the job as it is today. Wrong!! Maybe this government has the answer and will just make us work until we drop!

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  • Of course pharmaceutical companies shouldn't be paying for training, its a glaring and quite gobsmacking conflict of interest. However I can understand the appreciation of it when the GP's have such a tight hold on their profits and little enthusiasm for distributing it around a bit in a useful way.
    Its part of the general shambolic situation of nurse training. The unions and the NMC should be addressing this as a basic necessity not a luxury.

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  • I guess if GP's were not supported in their individual business empires and included in the NHS, it would go a fair way to solving that money down the drain issue of people in transit following training.

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  • I agree totally with Lynnie. So what if private companies want to teach us a few things? I'm happy to learn as much as I can, and I'm sensible enough to detect product placement in the training and know that many other products often do the same thing!

    I think it is good however that the piss poor lack of funding from PCT's to allow us to keep up with our CPD is finally being raised as an issue.

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  • I acknowledge the resourceful role pharmaceutical companies have played but let's face it, there has to be something in it for them, they don't do it purely as an act of altruism. It is a foot on the slippery slope. I nursed abroad, plus had my children in a country where pharmaceutical sponsorship was the only means doctors got to go on post graduate training. I was determined to breast feed my children and as far as I was concerned was doing a very good job. However,my paediatrician
    went to great lengths to convince me I had no milk, my baby was suffering and I should change to formula milk immediately before I harmed my new-born baby. Being a nurse (British bred) I stood up to the doctor and argued my case for continuing to breast feed. I was threatened with social services intervening and taking my baby into care as she claimed I demonstrated to be an irresponsible mother. Luckily the mid-wives (who don't depend on pharmaceutical funding) heard about my case and got involved straight
    away enabling me to change doctor and therefore avoiding social services taking my child away.
    Years later telling another Italian mum about my story because she had had exactly the same experience, it came out because formula milk companies fund peadiatricians training/conferences etc.
    Hopefully this will never happen in this country.

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  • I'm afraid it is already happening on a larger scale..what happened with your baby being threatened to be taken away...now its law in australia that if the psychiatrists (funded hugely by pharmceutical industry and drugging children younger and younger under the age of 10) that if they deem you child mentally ill (examples...temper tantrums) they can take them away even if the parents disagree. It's all about money...money...money...the same goes for the GPs who are being funded by these big pharm industries....this is serious stuff!

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  • If this is the state of practice nursing what will happen if GP's and Pharmaceutical companis are allowed to influence and run the whole healthcare system as the government suggests. Even if nursing and other disciplines take there development seriously will this devolved way of doing things improve patient care or fuel an unsavory side of bias

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  • Practice nurses and nurses working in Primary Care not only have to fund their own courses in many cases, but attend them in their own time and are not paid Agenda for change- oh I could go on .... So thank you Pharmaceutical Industry .

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  • Several points for me to make.

    The first is that I really appreciate the training provided by drug companies. I attend quite a few in my own time on a 'need to know' basis, because I am accountable for my own practice. I feel discerning enough to not support any particular drug because they the company offers me a free sandwich. In fact it is I, a practice nurse, who attends the lectures and leaves the food which is more than I can say for some GPs who want the free dinner, then try to leave!

    The second point is that, again, as accountable for my own practice, I feel it is up to me to decide what I need to learn, NOT a GP. I absolutely resent someone in a different profession deciding what I should update on or learn. So often I can pick up problems that patients feel have been neglected, or I have observed being neglected and take action.

    The third point is in my view, practice nurse training should not be in the hands of the medical profession. I have worked in 8 GPs practices in 11 years and only one of them supported nurse training in a professional manner. The one I have worked in for the past 6 years does not even think nurses should be prescribing and blocked me doing it. Because I have experienced such bad employing GPs before I have been reluctant to change again.

    In an era where we had Liberating the Talents not so long ago, and pushing boundaries, why on Earth is our training not more nurse led, including prescribing?
    Having written the above, I do also think nurse training should be more flexible and accept more self-directed study. I did a BSc Hons with the OU, then several modules at Level 3 and Masters with Insitutions in subjects I wanted, but still cannot access an 'advanced' nursing level because they always want so much more money and me to repeat much of what I have already done somewhere else.

    By the way. I am 56 and nowhere near intending to retire. I love my job, feel in my 30s, and eager to advance my nursing career if only my existing modules (that exceed the outcomes on most Spec. Practitioner degree programmes) were recognised without jumping through so many more hoops.

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  • I would like to do my asthma diploma, guess what GP wont fund, although they want me to do the work involved, awaiting funding from drug companies.

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