Ambitions to further boost the general practice nurse workforce were revealed in the NHS long-term plan, published this week. Nurses new to the register will be asked to take up a career in primary care in exchange for a two-year fellowship.
“Nurses are seeing primary care as an area in which they can learn new skills and advance their careers”
The plan stated: “This would offer a secure contract of employment alongside a portfolio role tailored, where possible, to the aims of the individual and the needs of the local primary care system.
“This will enable newly qualified nurses to consider primary care as a first destination role,” it added. The offer will also be available to newly qualified doctors.
Nursing Times has asked NHS England for further details about what the fellowship would involve.
Similar schemes run by the NHS in the past have seen GP fellows given the time and support to work on a project of special interest to gain additional skills while under employment with a practice. The fellow is also given funding to undertake a qualification relevant to their project.
It comes as latest figures reveal a 1.4% rise in the general practice nurse workforce over the past year. As of September 2018, there were 23,135 nurses employed in doctor surgeries in England – up from 22,816 in the same month in 2017, according to workforce statistics from NHS Digital.
“It has opened up the conversation about nurses and raised the profile”
But the data shows progress has been slow and has fluctuated. In September 2015 – the earliest comparable data available – there were 23,066 nurses in primary care.
Nevertheless, the upward trend in general practice nurses stands in contrast to their medical colleagues. The statistics show the number of general practitioners working in England has dropped by 3.4% over the three-year period, from 35,516 to 34,318.
While the overall increase in primary care nurses since 2015 is minimal, there has been a notable 22% jump in advanced nurse practitioners, from 3,427 to 4,189.
And the number of nurse partners has more than doubled over this time period, but is still a very low representation.
In September 2015, there were 18 nurses holding partnership roles within 7,674 surgeries, rising to 39 nurse partners within 7,182 practices in September 2018.
Dr Crystal Oldman, chief executive of the Queen’s Nursing Institute, said the figures showed nurses were beginning to become more recognised as a valuable member of the primary care team.
However, she said she believed more work needed to be done to ensure the titles used by nursing staff reflected their level of skills and training to patients.
Source: Kate Stanworth
“In nursing we absolutely need to understand and agree what constitutes and what describes and what standards and education go underneath a nurse practitioner and a nurse specialist and a practice nurse,” Dr Oldman said.
“I think there is also something about protection of the public,” she said. “If you go into a GP surgery and you meet a GP as a patient you know that that doctor you are seeing… has had a minimum of 10 years of preparation to become a GP.
“If as a patient you walk in and see a nurse, first of all is that a registered nurse or is it a healthcare assistant who is being referred to as a nurse, which happens and it’s legal to do that,” Dr Oldman explained.
“Secondly, if you do identify that they are a registered nurse, to what extend is their education and training regulated so that you know you are safe in their hands,” she added.
Dr Oldman noted that there was currently no system of regulation for nurses working at an advanced level – meaning staff could adopt the title of “advanced nurse” without the relevant credentials, echoing concerns that have been raised in the past.
Meanwhile, she said challenges around general practitioner recruitment had provided an opportunity to “showcase” the work of nurses in primary care and for the potential for them to expand their roles.
“It has opened up the conversation about nurses and raised the profile and I definitely wouldn’t like it to be seen as a competition as in we can swap out one GP for two nurses or whatever – it is absolutely about having the right practitioner meet the patient need,” she added.
Dr Oldman said in the six years she had been with the QNI she had noticed positive a change in the narrative used by general practitioners around nurses in primary care.
She added that more surgeries were becoming willing to take on newly-qualified nurses or give opportunities to student nurses, whereas traditionally they had sought to recruit those with experience in primary care.
In the summer of 2017, then chief nursing office Professor Jane Cummings launched a 10-point action plan designed to boost the general practice nursing workforce.
Dr Oldman said the new NHS Digital data showed this initiative was starting to make a positive difference and added that she anticipated the figures to rise further as the work continued.
Stephanie Aiken, deputy director of nursing at the Royal College of Nursing, said: “These figures show that nurses are seeing primary care as an area in which they can learn new skills and advance their careers.
“The quality and outcomes framework provided a wealth of opportunities for nurses in general practice and allowed nurses to take more strategic roles in providing care for patients with long term conditions and manage the delivery of health improvement programmes,” she told Nursing Times.
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“The increase in the number of advanced nurse practitioners is testament to how general practice is embracing multi-disciplinary working to cope with understaffing and increasing demand on GP services,” she added.
However, she raised concern that not all practice nurses enjoyed the same pay and conditions as other nursing staff in the NHS – highlighting that the RCN had been calling for the 2018 pay deal for those on the Agenda to Change scheme to be applied to primary care nurses.
She said shortages of nurses in general meant those on the frontline were under increasing pressure and without action this would get worse.
Ms Aiken noted that almost a third of general practice nurses were due to retire by 2020 and that the removal of the student bursary in 2016 had resulted in almost 900 fewer people embarking on a nurse degree.
“The best way to attract people to a career in primary care nursing and stem the effects of an ageing workforce is via a robust national workforce and training strategy and by properly investing in nursing higher education,” she added.