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'Landscape changing' for more nurse-led general practices

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A director of the only nurse-led general practice in the UK has signalled that more such surgeries could be on their way.

Julie Belton believes nurses’ aversion to risk-taking had so far prevented the model at Cuckoo Lane Practice in Ealing being replicated elsewhere despite its proven success.

“I think nurses are not always that good at taking the risk”

Julie Belton 

However, Ms Belton told Nursing Times she sensed the “landscape is changing”.

Cuckoo Lane was set up as a nurse-led practice in 2005, and in 2015 it was rated as “outstanding” by the Care Quality Commission.

The clinical governance is held by nurses and the majority of care is delivered by nurse practitioners and practice nurses. The practice employers two general practitioners who work between two to four hours a day.

Ms Belton, strategic and operational director and nurse practitioner at the surgery, held a workshop about the project at the National Student Nurse Congress held at St George’s Hospital in South London on Monday.

She told delegates that patient satisfaction was high, staff recruitment and retention was good and that the practice had scored 100% against its quality outcomes framework.

Since Ms Belton joined the team around eight or nine years ago, the patient list had grown by 2,000 to reach 6,000. 

During a question and answer session after her presentation, Nursing Times asked Ms Belton why, given the results, she thought Cuckoo Lane remained the only nurse-led practice in operation in the UK. 

“I think it’s about risk taking,” she responded. “I think nurses are not always that good at taking fthe risk and actually putting their hands up and saying I will do this.

“Because ultimately that’s what it is about, it’s about saying I’ve got this all covered,” Ms Belton said.

“There’s always a risk, when you are seeing sick people there is always a risk, but you just have to do everything in your power and that’s what nurses are really good at, they are good at ticking all those boxes but they are not so good at holding that risk,” she said.

However, Ms Belton said she believed the tide was turning, adding that she had around five emails in her inbox from people wanting to know more about the model.

“I think the landscape is changing so I do think there will be more,” said Ms Belton.

She said she wanted to see new nurses supported to develop the skills that would be required to lead a primary care unit.

“We are not the only people in the world who can do it, it’s about developing people who are able to carry that level of uncertainty,” she noted.

However, the road has not always been smooth for the Cuckoo Lane team.

“We are not the only people in the world who can do it”

Julie Belton 

During her presentation, Ms Belton, who leads to practice with clinical director Carol Sears, told how it received “a lot of opposition” in the first few years of operation, particularly from medics.

She revealed that one local general practitioner threw eggs at one the team member’s cars, while a letter was also received warning that the surgery was “doomed” because it was run by nurses. 

Meanwhile, Ms Belton told delegates that Cuckoo Lane allowed nurses to work at the ”top of their skill set”. 

The surgey had adopted a “flat” leadership structure where power was shared between staff and also patients.

It also promoted postive achievements on a “glimpse of brilliance” board in its reception to help keep staff motivated and feeling valued.

“People do much better with positives, we all know this it is basic stuff,” said Ms Belton.

“So when something good happens, when a patient says something good, when someone has passed a course, we celebrate it,” she added.

“One of practice nurses did a prescriber course and we said ’fabulous get it on the board’, and she wrote it in the smallest of writing,” Ms Belton noted.

“As nurses we are not, I don’t think, that good at bigging ourselves up and saying we are really good,”she said. “I say ‘no, we need to put that in big writing’.”

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