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Investing in primary care nurses improves practice clinical quality


GP practices that employ more nurses and invest strongly in their training and education tend to provide better care, according to analysis of data exclusively shared with Nursing Times.

The research suggests increases in nurse numbers and training levels improve performance on measures such as the proportion of patients whose blood pressure has been recorded and outcomes, including how many have safe blood sugar levels and how often patients with long term conditions have to be admitted to hospital.

The findings of a team led by Peter Griffiths, professor of health services research at Southampton University, have prompted calls for the health and social care regulator, the Care Quality Commission, to introduce stringent checks on practices’ training of nurses under its registration process which is due to come into force next year.

The most recent of the research papers, due to be published in the International Journal of Nursing Studies, says higher levels of nurse staffing and education are “significantly associated with improved clinical care for COPD, [coronary heart disease], diabetes and hypothyroidism after controlling for organisational factors”.

It says: “The benefits and importance of education, training and personal development of nursing and other practice staff was clearly indicated.”

This paper and two supporting papers look at how many nurses were employed by practices compared to the population they serve, and at measures of education and training recorded in GPs’ performance pay system – the quality and outcomes framework.

It examined whether staff receive basic training in life support skills, annual appraisals, inductin training and personal learning plans.

Professor Griffiths said: “The message is not only that you get better quality care with more nurses, it is reassurance that practices which are deploying more nurses seem to be delivering better clinical quality.”

He said results showed one of “best returns on investment” for practices was on improving education and training, where he said the affect on admissions for asthma and chronic obstructive pulmonary disease “is substantial and tangible”.

Professor Griffiths said practices were known to vary significantly on the quality and amount of training provided and, “in some cases nurses are thrown into areas such as chronic disease management without any training”.

NHS Alliance nursing network lead Ursula Gallagher, also NHS Ealing director of quality, said the CQC registration process should require proper education and training from practices for the first time. She said: “There is variation in employment practices - access to training and development is very varied and idiosyncratic.

“There is very little in the system that encourages or makes it more likely those things will happen, so we need to look at the CQC registration process, and what the standards are going to say about the role of nursing in primary care.”

Ms Gallagher also called for changes to the GP contract to encourage greater involvement of nurses at a higher level. That could include making it easier for commissioners to make GPs involve more nurses and “move towards a more multiprofessional model”. There are currently only a handful of nurses who are contract-holding partners in practices.

“One of the things the [government’s NHS] reforms were supposed to do was renegotiate the GP contract. We would like to make sure the opportunity for different models [to all-GP led] are strengthened and there are opportunities for nurses to be equal players,“ Ms Gallagher said.

Royal College of Nursing primary care adviser Lynn Young said: “We are well aware the variation in standards of education, training and preparation for the job is huge. But if you educate nurses you get better care and better outcomes.

“We would like to see the CQC encouraging GPs and practice managers to look at the training and education of practice nurses have got, so they are safe to do what they are asked to do.”

However, Ms Young questioned a general link between primary care nurse numbers and quality. She said: “The numbers game is a difficult one particularly when GPs vary in terms of what they do and what services they provide. The challenge is to get the balance right for each particular practice.”

A CQC spokesman said: “Registration requirements include having the right number of suitably qualified personnel.”


Readers' comments (6)

  • If the sun shines the grass will grow. How many more times do we have to read articles like this that tell us what we as nurses already knoW? But it's good that at last the rest of the world is starting to catch us up!

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  • oh, dear. it seems there are more people engaged in writing these reports and articles than there are involved in patient care.

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  • boohoo

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  • You can read Peter Griffiths response to various comments like these on another article that talks about this, basically saying that more Nurses = better care. No sh*t.

    I would like to see these researchers, along with the CQC (when it gets some teeth), the RCN (when it gets a backbone), and the NMC (when it starts actually supporting our profession for a change) actually pushing for the results of these innumerable studies to be put into practice, instead of allowing the powers that be to ignore them yet again.

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  • To anon 8 june, what does "boohoo" relate to?

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  • Anonymous | 13-Jun-2011 12:29 pm


    relates to my feelings of fatigue and resignation on hearing about the same old bits of research on the obvious being churned out over and over again year after year without any actions being taken on the recommendations to produce visible signs of improvement.

    not a very constructive criticism I know but a meaningful expression of my feelings generated by the same old excuses of lack of funding, lack of staff and the consequent lack of resources which ultimately reflect on patient care and working conditions!

    just plainly and simply, boohoo! there is nothing else left to say!

    I also wrote the comment immediately above that one, 8th June, 11.45.

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