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Nurses reject future merger of practice and district roles

  • 9 Comments

Practice nurses are “not interchangeable” with district nurses, according to a major new report, which reveals overwhelming frontline opposition to the idea of the two roles being merged.

The research published today by the Queen’s Nursing Institute, and based on a survey of more than 3,400 practice nurses, stressed the specialist nature of their role.

surveys

It suggested that, with the right training and support, practice nurses could be the solution to the current GP shortage by taking on more prescribing, working with people with long-term conditions and taking the lead in illness prevention.

However, it also revealed that staffing shortages in GP nursing teams were only likely to get worse, given a third of practice nurses were nearing retirement age, and that there was a need for better support to ensure primary care nurses fulfilled their potential.

The research pours cold water on the idea practice nurses could do the role of a district nurse and vice versa – a concept that has been discussed and found favour among some health service managers and commissioners.

Nurses who responded to the survey were “overwhelmingly negative” about the idea and said it simply would not work.

“The respondents were emphatic about the differences in the two specialisms and the need for specific and appropriate preparation for each of the specialist roles,” stated the report.

However, nurses did acknowledge the need for joint working, which could be best achieved if practice and district nursing teams were co-located at surgeries.

“This provides conclusive and overwhelming evidence from the practitioners that the specialist roles of the GPN and the DN are not interchangeable,” said the report.

“This is a critical message for consideration by policymakers and those who are involved in creating new service models within vanguards in England,” it added.

“The number of nurses planning to retire should be of major concern”

Crystal Oldman

Meanwhile, the General Practice Nursing in the 21st Century: A Time of Opportunity report highlighted the potential for nurses to play a much bigger role in supporting GP colleagues – and said this must also be taken into account when designing new models of primary care.

“They have the potential to support their GP colleagues in the team to a greater extent than they do currently; many already have the skills to not only assess patients, but to diagnose, prescribe and refer to other services,” said the report.

“With appropriate education and training, a greater number of nurses working in primary care can develop these skills, which will help to address the current shortage of general practitioners and provide an appropriate alternative to a GP consultation,” it said.

Just 10.6% of nurses who took part in the survey held an official specialist qualification in general practice nursing. Meanwhile, around a third were independent nurse prescribers.

Overall, more than 40% of practice nurses who took part in survey said they did not feel their nursing team had the right number of appropriately qualified staff to meet the needs of patients.

Not all felt their employers supported their professional development, with more than 40% saying it only happened sometimes or rarely.

Meanwhile, the survey found just 27% of employers offered placements to nursing students, compared to 61.5% who offered placements to medical students.

About 23% of practice nurses said they had more than one job, with some holding three different posts and one with as many as five.

However, this could be viewed as good news as it showcased the flexibility and variety of practice nursing as a career, said the report.

But it may also “indicate some nurses are compelled to hold more than one job for reasons outside of their control, for example to achieve a high enough salary to enable them to manage other commitments”, it noted.

The majority of survey respondents – about two thirds – did not feel their salary reflected their role and responsibilities.

Crystal Oldman

Crystal Oldman

Crystal Oldman

Variations in terms and conditions should be investigated, said the report, which called for better workforce planning to ensure there were enough practice nurses to meet local needs.

Steps must also be taken to boost the profile of the role so it is seen as a rewarding career, and increase student placements and the number of qualified mentors in primary care, added the report.

QNI chief executive Dr Crystal Oldman said: “This survey validates the role of the general practice nurse. They are a vital part of the healthcare system in every part of the UK.”

She also said the survey findings indicated “some major challenges and opportunities” that needed to be addressed.

“Many of today’s nurses are now undertaking roles traditionally the reserve of GPs,” she said. “There is a huge opportunity for increased investment in the general practice nurse workforce, to build the capacity of primary care, move more care to the community and closer to people’s own homes.”

But she added: “The number of nurses planning to retire should be of major concern and we need to ensure that enough nurses are attracted to the profession so that patients can continue to receive high quality nursing care for themselves and their families when they attend the GP’s surgery.”

Ruth May, nurse director at the regulator Monitor, said: “We welcome this report as it draws attention to some very important issues in general practice nursing, not least the number of extremely skilled nurses nearing retirement age.

“We are also delighted that Dr Crystal Oldman has agreed to chair the Sustainable Safe Staffing: Primary and Community Services group and we’re very much looking forward to working with her in the future,” she added.

 

Headline findings from the QNI survey:

 

Workforce

  • 33.4% of General Practice Nurses are due to retire by 2020
  • Men are under-represented, comprising only 2.0% of the General Practice Nurse workforce
  • 43.1% did not feel their nursing team has the right number of appropriately qualified and trained staff to meet the needs of patients
  • At the time of the survey, 78.8% had considered preparation for NMC re-validation

Education

  • 53.0% reported that their employer always supports their professional development
  • 10.6% hold an NMC recordable specialist practice qualification in General Practice Nursing
  • 32.6% of General Practice Nurses are independent prescribers
  • Just 27.0% of the employers offered placements for pre-registration nursing students, compared to 61.5% offering placements to medical students

Employment

  • 22.8% of nurses working in General Practice have two jobs
  • 32.6% of General Practice Nurses reported working evening sessions (after 6pm) and 18.5% work weekends
  • Over 38.3% indicated that they undertook visits to patients at home
  • Only 35% felt that their salary reflected their role within the practice
  • Salary and other terms and conditions such as annual leave entitlement vary widely
  • 9 Comments

Readers' comments (9)

  • michael stone

    'The research pours cold water on the idea practice nurses could do the role of a district nurse and vice versa – a concept that has been discussed and found favour among some health service managers and commissioners.'

    AND:

    'Nurses who responded to the survey were “overwhelmingly negative” about the idea and said it simply would not work.

    “The respondents were emphatic about the differences in the two specialisms and the need for specific and appropriate preparation for each of the specialist roles,” stated the report.'

    What looks good to managers, and what seems stupid to staff, can all-too-often be the same idea. But which 'commissioners' were these ? Many 'commissioners' are GPs these days, and surely they should know better ?

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  • Practice nurses to take over more responsibilities to address the deficit in GP's!!! Any salary increases planned to go with this or is it a cheap answer yet again?

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  • I have qualifications that GP's will not use! I an an Independent Prescriber and an ENP with minor illness/minor injury being a role I have used until I moved to my current practice!

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  • Hmm these roles are not interchangeable yet we are to believe that a generic nurse can care for anybody anywhere.....somebody needs to really consider what his miraculous generic nurse will be able to do

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  • Michael Stone

    "Many 'commissioners' are GPs these days, and surely they should know better ?"

    You comment hit's the nail on the head for me. We do indeed have a GP CCG lead in our area who previously blocked inclusion of PN's and discouraged GP employers to support PNs to do more.

    As a PN myself, I have been shocked how there has been little progress in GPs having to train in management and have knowledge of those they employ. In my experience, quite shockingly, even practice managers seem lacking in many instances, or flout it.

    As told to me. As long as GP's see general practice as their independent business, we will have this problem. GPs I have worked for so far (around 23), few seem to have a clue about skill mix, even if it saved them money and kept their staff motivated and retain good nurses, but sadly, all too many "partners" see their salaried nurse colleagues as disposable.

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  • PNs do an entirely different role to DNs, and if I were to attempt to work like a DN, I would have to neglect all the work I currently do within the practice. I am already stretched beyond capacity doing what I do as a PN, so to incorporate home visits for wound care, IV's etc would mean an awful lot of time off work training to actively de-skill my own role.

    Someone who thought of this generic nursing needs to decide if they want a lot of demotivated nurses with no specialised skills for patient care that are interchangeable, or continue to specialise the roles with advanced training to enable nurses to do more that GPs can share the workload with.

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  • michael stone

    Not quite on topic, and to RGN007 and the subsequent poster.

    It is remarkable, how 'inexpert' even senior NHS clinicians are, outside of 'their day job'. It is possible, that some GPs are not aware of any differences between PNs and DNs in terms of 'the job' - although it seems more likely, that GPs are 'looking at the problem from a different perspective'.

    I have been contributing to a thread about DNACPR at:

    http://www.bmj.com/content/352/bmj.i26/rapid-responses

    recently, and I still find it amazing how the stuff senior clinicians write about CPR decision-making, 'usually looks legally and logically wrong' from my patient/relative perspective - perhaps more relevant to the discussion here, some of the difference seems to stem from 'the medics only address what seems to be a problem FOR THEM, and then if the solution they come up with WORKS FOR THEM they seem satisfied'.

    You probably need to get more PNs and DNs onto CCG Commissioning Boards, if you want to short-circuit the type of 'PN = DN' thinking: I have no idea, how you get more nurses into those commissioning groups.

    The comments above that GPs are reluctant to allow senior nurses to use all of their skills, is not quite the same issue - but it is rather worrying, if widespread.

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  • Removed due to offensive nature.

  • michael stone

    24 JANUARY, 2016 9:31 AM

    Gardening, and most other activities, are less suited to my capacities. And it is a bit rich that you keep 'having a go at me' anonymously - anonymous posters, should not 'attack named posters', unless they are trying to achieve a 'very low personal status'.

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