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'Giving students experience of general practice is now urgent'


Jane Warner highlights the urgency of transferring the expertise of general practice nurses to new generations of student nurses - which requires a shake-up of pre-registration education

Around 90% of patient contact in the NHS happens in general practice. It is estimated that at least one in five nurses working in this setting are aged 55 or over, and expect to retire within five or 10 years. This is no surprise to anybody working in general practice, perhaps apart from those who hold the reins in deciding clinical priorities.

Until now, the strategic approach to workforce planning seems to have done the equivalent of covering its eyes with its hands and hoping the problem sorts itself out. Time and again, warnings are given about this demographic time bomb. But, when over 20% of a highly experienced workforce effectively disappears into the sunset, the most likely outcome will be a glib recommendation to those who remain to work smarter, not harder.

Deferring retirement is not viable. After a lifetime of service, it could be argued that for many of us, the spirit and commitment to care remains strong but physically it becomes more and more difficult.

Looking ahead to 2020 or thereabouts, if the expertise of general practice nurses (GPNs) is effectively lost and not replaced, what services could be threatened? At the very minimum, patients would not receive care closer to home. The management of long-term conditions, such as asthma, diabetes, chronic obstructive pulmonary disease and cardiovascular disease, as well as anticoagulation monitoring, travel health, family planning, obesity and hypertension management will fall into the laps of GPs, making a mockery of skill mix. Primary and secondary prevention encompasses much of GPNs’ work, reducing the need for more costly and complex hospital interventions. Nurse practitioners assess, diagnose and treat patients with undifferentiated illnesses, a service that may lead to inappropriate attendance at accident and emergency departments.

We need radical, joined-up thinking involving the Department of Health, higher education and GPs, and we need it right now. Key additions to general practice teams must include healthcare assistants and assistant practitioners who have been rigorously prepared for their roles. General practices are effectively independent businesses, and need to balance their books so taking on new staff might be seen as a financial risk. That said, it is encouraging that some newly qualified nurses have been able to achieve employment as GPNs.

Working as a GPN is no easy option. As nurses new to this field quickly realise, there is a world of difference between the skill sets required as a GPN and those acquired in other placements during pre-registration education. If I hear the words “steep learning curve” even one more time I shall probably scream.

Such a comment surely emphasises the need for an urgent shake-up of pre-registration education. We must ensure students have placements in general practice, to sample its culture, to learn skills under supervision, to attract newly qualified nurses to this demanding, fulfilling sector and to head off a looming workforce crisis.

Jane Warner is nurse practitioner, Creech Medical Centre, Somerset.



Readers' comments (6)

  • I absolutely agree. Student nurses need placement experience at the GP practices. I wonder if they will allow this since you mentioned they are effectively independent. It should be noted that care/nursing is moving to the community and more so managing long term chronic condition. The above mentioned conditions are managed in the GP practice. I belief student placements at the GP will attract future GPNs thus, ease future workforce crisis.

    Student nurse
    Birmingham city university.

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  • If you look at the adverts for practice nurses, they almost always ask for experience in this that and the other; skills such as smear testing. How does one gain such experience unless a forward thinking GP practice offers training? There are many experienced nurses, including myself, who would like the chance to develop into a practice nurse role.

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  • Maryam Omitogun

    General Practice Nursing Training is the best when we are talking of been a Registered General Nurse or been called a NURSE.

    I believe before an Individual is called a Nurse, He or She would have undergone a short period of theory/practical training in all aspects of Nursing such as Adult, Paediatrics, Neonate, I CU, Mental, Obstetrics and Gynaecology, Theatre, ENT, Surgery Medicine, Accident and Emergency Nursing etc. I was trained like I mentioned above.

    As Student Nurses We rotates in all departments every four to six weeks to have practical experiences. The rest were used for classroom lectures. Within the three years that we spent for the Nursing training separate six months experiences was for O&G and Psychiatry classroom/hospital Experiences.

    As a trained General Nurse one will have confidence and will be able to practice in any area and would have got experiences in working with adults, neonate and children. It is very obvious that one cannot have interest in all the areas but one can easily choose any area individual have more interest and confident in working.

    I believe for someone to call him/herself a Nurse, he/she should have got experiences/skills/knowledge in all department in Public Health and should be able to practice confidently with all cadres of people be it children ,adults or neonate.

    If this is not been practised worldwide, I think it’s the high time this is reintroduced or restart afresh.

    Maryam Dolapo Omitogun
    Greater London.

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  • hi, definitely needed, as a practice nurse though i find it difficult to sometimes draw in the student nurses. A certain amount of understanding of the chronic conditions we deal with is needed to get the most out of a placement,which through no fault of their own ,they dont have.
    I for one would benefit from guidance and pointers to help students gain the most from their placement.i.e what do they need to achieve whilst they are with us

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  • As a student nurse at the end of my 2nd year I feel if we are to have a placement with practice nurses it should be in 2nd or 3rd year if only as we have more experience with patients and have developed some skills that would be useful.

    Having spent 4wks with a community nurse this year I learnt a lot from my mentors on wound management and effective communication with patients who have various social needs and comorbidities that impact on them, these are skills that we could learn in a GP practice.

    Gillian Pulford | 20-May-2014 2:14 pm. I am not sure about every university, but the one that I attend provides us with a book that includes essential skills clusters with skills etc that we must complete and sign off over the year. Reflecting back over the year I can think of numerous skills that I have completed this year that would be applicable and could have learnt in a placement at a GP. For example, peak flow and management of asthma, wound care and dressings, injections/immunisations, communication and especially public health promotion.

    I think the key thing is allowing the student to take the lead under supervision when completing skills. I find the best Mentors are those that either show/direct me in what I need to do first (so I know what to do) and then allow me to complete the care, or the next one, with their supervision. The problem is when you go to a placement and are made to sit and watch even though you ask is there anything I can do...

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  • An interesting article, I am a student nurse currently on placement at a GP practice and would now most certainly consider this role when I qualify, very varied and interesting work before being placed here I would have said a practice nurses job is boring...not opinion has completely changed!

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