The remodelling of primary care and push towards more wide ranging but person-centred and community-based care has put a flashlight on the integral role of practice nurses.
General Practice Nursing in the 21st Century: A Time Of Opportunity says practice nurses have a significant contribution to make to by offering '‘a comprehensive and supportive nursing service to patients, which focuses on health promotion and supported self-care’.
What could seriously jeopardise their key role is a workforce crisis.
The QNI report, which surveyed 3,405 nurses, revealed that 33 per cent of practice nurses are due to retire by 2020.
Dr Crystal Oldman, chief executive of the QNI says the shortage of nurses in primary care is a major concern. 'Around 10 per cent are retiring each year which is an enormous number. GP services are finding it a challenge to recruit suitably qualified or potential practice nurses that could be trained. Practices are reporting having to poach from each other but this is not a sustainable solution.'
Jennifer Aston, an advanced nurse practitioner at Granta Medical Practices in Cambridge and the RCGP’s nurse champion, says a survey carried out in 2014 by the RCGP also warned that a large percentage of experienced nurses are nearing retirement. At the same time a 'very small percentage' of practice nurses are under 40 years.
'We are in a workforce crisis,' she says, 'although it can vary area to area.'
A major factor in this is a lack of appropriate training and development, and clear career route for practice nurses.
To address this, NHS England’s GP Forward View said that it and Health Education England (HEE) will, among other measures over the next five years, invest an extra £15m into general practice nurse development and roll out the HEE District Nursing and General Practice Nursing Service Education and Career Framework launched last October.
What does this mean for practices?
For the first time, the framework provides practices with a clear view of the specialist knowledge and skills needed to deliver general practice nursing, pinpointing the standardised roles and responsibilities for each of eight levels that make up the structured career pathway.
The levels start at pre-employment, progressing to healthcare assistant, assistant practitioner, general practice nurse, all the way up to advanced nurse practitioner. Minimum professional and educational requirements are set out for each role.
Professor Lisa Bayliss-Pratt, HEE's director of nursing and deputy director of education and quality, says the framework will ensure that general practice nursing professionals are equipped to deliver health outcomes now, and in the future.
'It supports the shift of care from acute into primary and community settings - a key element of the Five Year Forward View. New models of care will only become a reality if we have staff with the right skills, values and behaviours to deliver them.'
Ms Aston says the framework will offer GP practices more clarity. 'Medical training is fundamentally different to nursing. GPs have a proper framework and appropriate training for general practice. As yet, there are no national standards for nurses while we await those being developed by the QNI.
'Implementing the HEE framework is about giving appropriate-level training and support to practice nurses so they can deliver a service safely. Now it now needs to be given a higher profile and widened out.'
The pot of £15m will be vital to ensuring the framework can make an impact on the ground and improve numbers in practice nursing. However where should spending be targeted?
Creating more practice nurses
There is a clear expectation that practices will have to play their part in better supporting training and development. Therefore, one priority is opening up a greater number of general practice placements to student nurses to help create a steady, available and skilled workforce pipeline. Many barriers exist in this respect.
Ms Aston explains: 'There has to be a training ethos and environment within practices for a start. Rising workload and lack of time are further reducing capacity for offering training. In addition, there is not enough funding in general practice to invest in training programmes, and while there is external funding that can be accessed via Community Education Provider Networks (CEPN), it can involve complicated paperwork and considerable time to access.'
The training (non-medical) tariff given to practices may also be insufficient to cover the amount of time required from staff to support good learning practice.
And all this is compounded by the fact there are significant gaps in mentoring capacity.
'Nationally, we have a nursing workforce shortfall that affects the numbers of nurse mentors,' says Kathryn Yates, professional lead for primary, community and integrated care at the RCN.
'Student nurses require a mentor. Within general practice, issues such as workload or the fact a nurse may be single-handed and/or part-time can be challenging when considering accepting a student. Mentorship is an essential ingredient and requires more support if we are to develop and grow the general practice nursing workforce.'
Although, even without extra money, there are solutions that could be developed such as collaborating and sharing student placements, she adds.
'GP practices need to be adequately supported by education providers and CEPN,' says Yates. 'But practices also need to better engage with opportunities to support pre-reg nursing placements. They won’t have a nursing workforce for the future if they don’t.
'As part of that perhaps we need to consider whether offering placements should be better incentivised. It may be that part of the £15m should be spent on raising the training tariff.'
'There is short term thinking right now with everyone doing their own thing,' adds Ms Yates. 'But there needs to be a collaborative approach from general practice if we are to address this workforce issue, long term.'
Ms Aston says a HEE national strategy for developing general practice nursing is currently being formulated to tie all the stands together and which will be launched in October.
As part of that, a separate how to guide for GP practices on supporting and training practice nurses will also be launched.
'We need to look at a 21st century approach to general practice nursing rather than 20th century,' Ms Aston says.
What are the skills, values and competencies required by general practice nurses?
The HEE District and General Practice Nursing Service Education and Career Framework covers 13 areas. Examples include: