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How to ... Understand practice nurse roles

Sue Cross explains the qualifications and skills needed by different practice nursing team members.

Fully understanding the roles, skills and qualifications of practice nurses and healthcare assistants (HCAs) will help GPs deliver high-quality patient care and increase job satisfaction for these valuable team members.

The descriptions below are based on the General Practice Nursing Career Framework.

For career progression, practice nurses need skills in managing long-term conditions

Healthcare assistant
Level 2: Undertakes basic tasks within defined protocols supervised and supported by a registered practitioner (normally a nurse).

The HCA is skilled in tasks such as BP monitoring, venepuncture, checking and teaching inhaler technique, screening, application of dressings and urinalysis. They should have an NVQ2 or in-house training assessed at National Occupation Standard 2.

To progress within the career framework the HCA must do more training and education.

Senior HCA
Level 3: Has a higher level of responsibility. Works within defined protocols supervised and supported by a practitioner.

Skilled in a range of tasks which may include spirometry, venepuncture, flu vaccinations and so on. Requires an NVQ3 or equivalent HCA award.

Progressing within the career framework requires experience working with qualified staff in long-term condition clinics, simple wound care, and developing reflective and critical thinking.

Assistant practitioner
Level 4: Works with proximal (nearby) supervision and, supported by protocols, carries out tasks delegated by a registered practitioner (normally a nurse).

The role involves delivering clinical care previously performed by registered professionals. Performs a wide range of clinical activities and contributes to planning of care and patient education.

Needs a foundation degree plus a portfolio to demonstrate clinical skills competence.

Progressing within the career framework involves a three-year general nursing study programme with placements in a variety of healthcare settings and includes shift work.

General practice nurse
Level 5: A registered nurse (RN) provides services to defined groups within the practice population. Engages in protocol-based activities.

These nurses are most frequently registered practitioners in their first or second post-registration job. Skills required are consolidating learning since registration; putting a range of skills into practice; and developing a range of practice nursing competencies.

The nurse will have undertaken a basic introduction to general practice nursing accredited course.

Progressing within the career framework requires basic treatment room competencies and completing a variety of relevant CPD courses.

Senior general practice nurse
Level 6: RN responsible for delivering all general practice nursing services to the practice population and contributing to protocol creation and care.

These are usually nurses requiring a higher level of autonomy and responsibility. The nurse needs clinical skills such as long-term conditions management, and should be working towards an honours degree and mentorship.

To progress within the career framework the nurse must be competent in managing a wide range of long-term conditions, have an interest in public health and have attained an honours degree in nursing and mentor's qualification.

Lead general practice nurse
Level 7:
Involved with delivery and planning of safe, effective nursing care to the whole practice population. Leads and manages a nursing team working closely with practice manager and GPs to deliver practice priorities.

Creates practice protocols with team engagement. This is an experienced clinical professional who has developed their skills and theoretical knowledge to a very high standard.

They are empowered to make high-level clinical decisions and may have their own caseload.

The nurse needs good knowledge of treatment and medication management; a high level of interest in and awareness of public health; the ability to identify the practice population's needs and use evidence-based practice. A lead nurse is likely to specialise in at least one long-term condition or in first contact care.

An RN and non-medical prescriber, they should have an honours degree or equivalent; a mentorship/teaching qualification plus CPD accredited courses such as triage. Progressing within the career framework requires leadership skills, a non-medical prescribing qualification, diagnostic skills and an understanding of practice-based commissioning.

Advanced nurse practitioner (ANP)
Level 8: An experienced nurse who provides care from initial history taking to full clinical assessment, treatment, management and evaluation.

Able to refer directly to specialists, the ANP advises on protocol content. They work at a very high level of clinical expertise and/or have responsibility for planning of services.

ANPs need masters degree level skills in assessment and diagnosis, non-medical prescribing, leadership, negotiation and influencing and teaching. A strategic awareness of the practice population is needed. This is an RN with a non-medical prescribing qualification meeting requirements for advanced practice indentified by the Nursing and Midwifery Council.

To progress within the career framework the ANP needs experience of financial management and budget control and an interest in business administration and should participate in practice-based commissioning.

  • Ms Cross is senior research fellow in primary care at London South Bank University


Education points
  • A foundation degree - see assistant practitioner - is normally a two- to three-year part-time work-based learning programme equivalent to an undergraduate diploma at a university or further education college.
  • The Nursing and Midwifery Council (NMC) requires mentors - see lead general practice nurse - to have at least 12 months post-registration experience and to do a mentorship course.
  • Non-medical prescribing - see lead general practice nurse - can be accessed only by registered nurses with at least two years post-registration experience. Courses must be NMC-approved.
  • Masters level study - see advanced nurse practitioner - includes application of research and assimilation of new ideas. All masters degrees require a dissertation.

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