England’s chief nursing officer has today launched an action plan designed to boost the general practice nursing workforce and ensure it is “fit for the future”.
Titled General Practice – Developing confidence, capability and capacity, it is an attempt to alleviate the pressure faced by the primary care workforce from a growing older population with multiple complex conditions.
“The importance of our general practice workforce will only increase”
The CNO said the new 10-point action plan was intended to meet current workforce “challenges” by attracting new recruits, supporting existing staff and encouraging others to return to practice.
To promote careers in primary care, efforts will be made to raise the profile of practice nursing by offering clinical placements for undergraduates and supporting additional routes into the sector.
In addition, all nurses new to general practice will have access to an induction programme, training and mentoring and an expansion in leadership and career opportunities.
Meanwhile, the national return to practice programme, which is run by Health Education England, will now also include practice nursing.
As a first step, four regional “delivery boards” will be set up and will be accountable for developing a local plan for delivery of the action plan.
“We must not delay making general practice an attractive career for nurses”
The 23-page action plan – promised in NHS England’s 2016 General Practice Forward View – is backed by a £15m investment and includes “key milestones” to measure progress in practice nursing for the first time.
Last April, NHS England promised to invest in practice nurse development and return to work schemes, as part of its multi-billion plan designed to “get general practice back on its feet”.
It promised a five-year general practice nurse development strategy, with an extra minimum £15m national investment.
Launching the new action plan, CNO for England Professor Jane Cummings said: “As the NHS transforms the way that we deliver care – treating more patients in the community – the importance of our general practice workforce will only increase.
“Nurses working in general practice may not have always received the recognition they deserve in the past but they are central to our plan to improve care for patients and ensure the NHS is fit for the future,” she noted.
“That is why I am determined to ensure that there is a proper career development programme for those who choose this vital path and make it an attractive first choice for newly-qualified nurses as well as helping experienced staff take advantage of the flexibility it offers to re-enter the workforce,” she said.
“As patient demand has soared, numbers of practice nurses, like GPs, have not kept pace”
Dr Arvind Madan, GP and NHS England’s director of primary care, added: “General practice nursing teams are a vital component of the general practice workforce. This support plan will go a significant way in supporting general practice, helping deliver the care that matters most to patients.”
The plan was welcomed by a range of professional bodies and unions, representing both nurses and GPs.
Wendy Preston, the Royal College of Nursing’s head of nursing practice, said: “This framework for action recognises the tremendous contribution and challenges faced by general practice nurses and their teams, and highlights their pivotal role in delivering care closer to home.
“With large numbers of the workforce set to retire in the next few years, we must not delay making general practice an attractive career for nurses,” she said.
“General practice nurses are well placed and indeed deliver high quality services, meeting the needs of their practice populations every day,” she said. “We need to prioritise general practice and make it the ‘place to be’.”
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Lorna Collingwood-Burke, chair of the NHS Clinical Commissioners Nurses Forum and chief nursing officer of Northern, Eastern and Western Devon Clinical Commissioning Group, said the plan gave “welcome recognition” at national level to the “vital role” that general practice nurses played.
The forum is part of NHS Clinical Commissioners, an independent membership organisation representing 90% clinical commissioning groups in England.
Ms Collingwood-Burke said: “Our members have been raising concerns about the difficulties they are facing when it comes to the recruitment and retention of this essential component of their local workforce.
“This plan to support general practice nurses plays an important step in starting to address these challenges,” she said.
She added that nurses in CCGs were “uniquely placed” to support local implementation of the action plan, including the setting of appropriate targets for the extra staff required by local systems and new models of care.
“We look forward to working with NHS England to make sure that the crucial perspective of the commissioning nurse is fully embedded in the decision-making process locally when it comes to supporting the general practice nurse workforce,” she said.
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Meanwhile, Professor Helen Stokes-Lampard, chair of the Royal College of GPs, highlighted that nurses were “incredibly important members” of the practice team – highly valued by GPs and patients alike.
“The college has been calling for elements of this plan to be introduced for many years, so we’re really pleased to see wheels being put into motion,” she said.
“We now need all aspects of this plan to be implemented in full and as swiftly as possible – and we will play our part in ensuring it is a success,” said Dr Stokes-Lampard.
“We look forward to welcoming, and welcoming back, as many practice nurses to the profession as possible,” she added.
According to survey results published last year by the British Medical Association, half of the GP practices that responded said patient care was “deteriorating” due to rising workloads.
A Queen’s Nursing Institute report, also published in 2016, found practice nurses in London were working longer hours and had greater workload burdens than in other areas.
It painted a concerning picture of the strain on surgeries across the capital, with nearly two thirds of nurses saying their team did not have the right number of qualified staff to meet patients’ needs.
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In addition, last year the first national breakdown of clinician type in GP surgeries in England revealed the make-up of the practice nursing workforce.
The figures published by the Health and Social Care Information Centre showed that practice nurses and advanced nurse practitioners dominated among the primary care nursing workforce.
More than three quarters – nearly 77% – were practice nurses, while the second biggest group were advanced nurse practitioners at about 17%.
Just under 4% of nurses in general practice were specialist nurses, while just over 1% were extended role practice nurses, according to the HSCIC report.
Meanwhile, Health Education England published its General Practice Nursing Workforce Development Plan – Recognise, Rethink and Reform, in March this year.
It included a series of recommendations for organisations to influence the general practice nursing workforce to take forward and built on findings from Ipsos Mori research, including a report published by the QNI called General Practice Nursing in the 21 Century – a time of opportunity.
The 10 points in the action plan are as follows:
- Raising the profile of nursing in general practice – the ‘Image of Nursing’ programme will form the basis of this work, recognising the important contribution of the GPN workforce as well as promoting it as a highly valued career option.
- Supporting leadership opportunities – Equipping GPNs with the skills and competencies to take on leadership positions through greater access to leadership programmes, mentors and training hubs.
- Increasing the number of pre-registration placements in general practice – increasing the number of placements available in general practice to give undergraduate nurses a chance to experience what it is like to work in primary care. HEE will work closely with HEIs, encouraging trainees to take up placements in general practice.
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- Establishing inductions and preceptorships – going forward all nurses new to general practice will have access to an induction programme and a professional development plan.
- Improving access to ‘return to practice’ programmes – by sharing best practice from existing return to work programmes. The national return to practice programme will also include GPNs.
- Delivering on prevention – nursing will play a crucial role within primary care, including mandatory health checks, supporting and educating the public about their general health, helping people lead healthier lifestyles to try and avoid ill health.
- Access to educational programmes geared towards delivery of care needed in the future – Programmes will be targeted towards skills needed to enhance practice, achieving better outcomes, experience and use of resources. For example, working with practice population health profiles and enhancing care through digitalisation including promoting healthy ageing and physical activity.
- Expanding career opportunities and progression for GPNs – by increasing access to clinical academic careers and advanced clinical practice programmes allowing new entrants to work in a number of roles, with the option of progressing to more senior roles such as Advanced Nurse Practitioner and clinical roles, which in the past may not have been an option.
- Offering additional routes into general practice – developing new career pathways into primary care nursing including Nursing Associates and Health Support Workers. The regional boards will use emerging best practice from schemes such as the primary care Nursing Associate pilot in Gloucester.
- Improving retention – Working with NHS Improvement, the four Regional GPN Boards will support the introduction of successful initiatives relating to the retention of GPNs to enable all practices to share and adopt best practice.