Earlier this week I attended a conference for GPs in London. Not the most obvious event for the news editor of the Nursing Times to attend, I admit. But there was a good reason.
As well as a small knot of practice nurses sitting among all the GPs, the chief executive of the Queen’s Nursing Institute was in attendance at the Londonwide LMCs (Local Medical Committees) conference. Dr Crystal Oldman was there to present the findings of a major survey of the capital’s practice nurses.
Dr Oldman revealed that London’s practice nurses worked a greater number of hours of unpaid overtime per week than others around the UK, and were more likely to report that their nursing team did not have the right number of appropriately qualified staff to meet the needs of patients.
”London’s practice nurses worked a greater number of hours of unpaid overtime per week than others around the UK”
She also highlighted that a small, but still worrying, number of practice nurses in the capital were being paid a similar wage as a band 4 healthcare assistant, while others thought they still had indemnity from being a member of the Royal College of Nursing – which they don’t.
But what stood out for me was the question and answer session that followed. The other two panel members who had presented earlier during the session were forced to sit impassively by, while all of the questions and points made by the GPs – bar one – were aimed at Dr Oldman.
And, somewhat unexpectedly, the main focus was not on the pressures facing practice nurses, it was with the government’s plans to replace student nurse bursaries with loans. What was most concerning the GPs was not the workforce pressures now, but the future supply of practice nurses and how it might be affected by a move to loans.
One highlighted the problem of providing training placements for practice nurses without any funding, another urged doctors to support the student campaign to retain the bursary and one described attracting and retaining nurses and healthcare assistants as one of the “most important things” determining the survival of general practice.
In response, Dr Oldman described how she had been at a school careers event the previous night, where a lot of parents had told her they were no longer supportive of their children studying nursing because of the combination of a large loan and lower earning potential than many other professions.
This was the first time I had heard evidence suggesting that the ending of the bursary could have a negative effect on student numbers, rather than just warnings that it might.
”This was the first time I had heard evidence suggesting that the ending of the bursary could have a negative effect on student numbers”
Of course, the next day, NHS England calmed GP nerves when it revealed its General Practice Forward View, with its promise of a larger slice of the NHS budget and 5,000 more doctors over the next five years.
It also included pledges to support the non-medical workforce, including a general practice nurse development strategy backed with a minimum £15m investment.
We were told it would cover improving training capacity in general practice, increases in the number of pre-registration nurse placements, measures to improve retention of the existing nursing workforce and support for return to work schemes for practice nurses.
There were also promises to roll out training and career frameworks recently developed by Health Education England and the Queen’s Nursing Institute.
The RCN, Unison and the QNI were all pretty welcoming of the plan, noting it as “step in the right direction”. I also thought it a very welcome and much needed focus on primary care and the community, given the years of rhetoric surrounding the need to move more care out of hospitals.
Although, I also noted the potential role expansion of practice nurses seemed to be mentioned less than other groups like pharmacists and physicians assistants, as did linking them to specific recruitment targets.
But, without wanting to put too much of a downer on everything, the plan will be quite hard to deliver if the supply of students wanting to become practice nurses dries up.
Dr Oldman’s experience at the school parents’ evening should signal the first warning – if an anecdotal one – that the dreams of ministers and the Council of Deans of Health about thousands of applicants queuing up for course places may not become reality.
And, of course, this will not only be a problem for general practice. As the GP conference’s well-known comedian and political commentator Dr Phil Hammond noted, it’s all “looking rather scary”.