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Interview: CNO's new plan to boost practice nurse workforce in England

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Offering a more “flexible” career path will be key to encouraging more newly-qualified nurses into general practice settings and to also tempting former staff back, according to the chief nursing officer for England.

Last month Professor Jane Cummings 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.

Speaking to Nursing Times, 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.

“What we really want to build is the opportunity for people to have flexible working”

Jane Cummings

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.

Nursing Times asked the CNO which of the 10 action points she considered to be the most important.

“The first one that I really want to concentrate on is how do we retain the nurses that we’ve got in place and that will be about listening to what will keep them in the job,” she said. Secondly, she highlighted encouraging former nurses to return to practice, especially those that wanted a more “flexible job”.

She acknowledged that there had been “some mixed responses” to broader nursing return to practice schemes in recent years. The CNO said she thought what people considering going back into practice wanted was a “really flexible role”, which was sometimes hard to find in other settings. “I think working in primary and community care often does give that flexibility,” she said.

“If we do that three-pronged approach as the absolute priority, then we’ll start to see improvements”

Jane Cummings

She added: “The other key action point I would concentrate on is improving the number of clinical placements for undergraduates, so we start to see student nurses spending time in general practice and some of the new primary care hubs, and really understanding what the role of the practice nurse can and should be.

“What we really want to build is the opportunity for people to have flexible working – the portfolio careers that a lot of the generation that are now qualifying want to see,” said the CNO.

“If we do that three-pronged approach as the absolute priority, then we’ll start to see improvements and we’ll start to build that really great career pathway that practice nurses can have,” she said.

The CNO also highlighted a wider piece of work on the overall “image of nursing” that she will be working on with the Royal College of Nursing with the aim of boosting recruitment and retention.

She first outlined the project at her annual summit earlier this year, saying it would focus on promoting the “image and pride of our profession, tackling misconceptions and stereotypes”.

Professor Cummings said: “We know that in order to recruit and retain nurses into the workforce, whether that be in primary care or elsewhere, then actually promoting a positive image – despite the challenges people face and we clearly recognise are there – is really important.

“When I speak to frontline nurses, they do often talk about wanting to really celebrate the great work they do, as well as wanting people to acknowledge the pressures that they work under. At the moment, we don’t always get that balance right and I think it’s really important we try and show the positives as well,” she said.

“When I speak to frontline nurses, they do often talk about wanting to really celebrate the great work they do”

Jane Cummings

Professor Cummings said that, along with the RCN, she was currently in the process of engaging with representative from the education sector and the frontline to talk about “how they would like us to show the image, and it will be a range of things”.

“I don’t want to pre-empt what the outcome of the group will be, but the important thing, for general practice nurses in particular, is really highlighting the work that they do and the work that they can do and what a great career opportunity this will be when we’ve been able to follow through all of the different actions that we’ve set out in the plan,” she said.

As a first step, four regional “delivery boards” will be set up in August and will be accountable for developing a local programme for delivery of the national action plan.

The CNO said that by October she was looking to have identified the universities that would deliver the return to practice programme and by December to have established the baseline numbers of nurses working in general practice and also pre-registration placements.

“Then in December we are going to set some specific targets for each of those so there is a very clear deliverable for us to work towards,” she said.

The action plan – promised in NHS England’s General Practice Forward View – is backed by a £15m investment and includes “key milestones” to measure progress in practice nursing for the first time.

“The role of practice nurses is going to be even more critical in the future”

Jane Cummings

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.

“We’ve got £15m, which is not a huge amount, but its £15m dedicated for this programme,” said Professor Cummings.

“It’s the first time since I’ve been in any senior nursing leadership position that general practice nurses have had a specific focus, with money and action,” she said. “The practice nurses I’ve spoken to have really been hoping that this would happen and we’re proud that we’ve been able to do that.”

Asked if she was confident of getting buy in on the strategy from GPs, she highlighted that the Royal College of GPs has been “very supportive” of the idea, as had GPs she had spoken to personally.

“I’ve not had any GPs say that they don’t support it and they don’t support the need for their general practice nurse to be well supported to have a proper career,” she told Nursing Times.

NHS England

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Jane Cummings at Expo 2016

Professor Cummings acknowledged, though, that “inevitably” there would be some out of the 8,000 practices in England that “would be more difficult to engage with this agenda”.

“But to be honest, the sorts of pressures and the type of work that we want people to do in primary care and the community – actually – the role of practice nurses is going to be even more critical in the future,” she said.

She added: “When people see general practice nurses and those nurses in the system that are thinking about a career in the out-of-hospital setting, I think they will see this is as a really good opportunity to get a satisfying career pathway – that enables them to progress and do different levels of clinical practice in that primary care setting and work as advanced practitioners alongside GPs.

“I know nurses who are advanced practitioners who have their own clinics, in some cases who run the surgery, lead the surgery, and I think there are some really good opportunities for the wider professional team to work together for the benefit of patients in primary care,” she noted.

“I think they will see this is as a really good opportunity to get a satisfying career pathway”

Jane Cummings

Asked by Nursing Times how she would judge the success of the new strategy, the CNO said: “If we’ve improved retention, we’ve improved the number of undergraduates, that we’ve actually improved the number of practice nurses and we’ve created and delivered this career pathway and structure for nurses in primary care then that will be a huge success, I think.

“The most important thing is that this is the start of a programme that we think will raise awareness about the role that general practice nurses play and really enhance it,” she said. “Because it’s not the sort of thing that many students and newly-qualified nurses necessarily think about.”

The plan’s launch comes against a background of growing concerns about the demands being paced on the primary care workforce.

A Queen’s Nursing Institute report, 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.

Meanwhile, 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.

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Readers' comments (1)

  • “The first one that I really want to concentrate on is how do we retain the nurses that we’ve got in place and that will be about listening to what will keep them in the job

    EASY Ms Cummings ..... Respect us, support our reasonable requests for a decent pay rise, acknowledge we are overworked and underpaid, too much paperwork and box ticking, bullied by the NMC.

    Importantly don't undermine Band 5 nurses with what seems to be a huge roll out of associate nurses.

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