Supporting Practices nurses in the new world of General Practice

Dr Marina Lupari

Professional Lead for Primary & Community Care

Royal College of Nursing

Dramatic Changes in Health Care Aging population Growing diversity Global health care system Bio-medical advances New areas of knowledge, i.e.

genetics, environmental health

Where are we now?

3

An alternative guide to the new NHS in England by KingsFund

https://www.youtube.com/watch?v=8CSp6HsQVtw

The news:

ageing population and changing consumer expectations>increase in demand for GP appointments.

45 million more appointments every year compared to 5 years ago

The number of people unable to get an appointment has been rising and public satisfaction with access to GPs is falling.

People finding it too hard to see their GP and GPs are finding it harder to give the kind of personal care that is the hallmark of their profession.

Primary care workforce/infrastructure:problems

Increasing the primary and community care workforce by at least 10,000, including an estimated 5,000 more doctors working in general practice, as well as more practice nurses, district nurses, physicians’ associates and pharmacists

A new deal on infrastructure

BUT…a new deal on access with a seven-day NHS

Solutions

Innovative Experiments:

1965: Duke University PA Program

Charles HudsonThelma Ingles

5YFV/Vanguards – new care models

Prevention

Empowering Patients

Engaging

Communities

New Models of

Care

Local Leadershi

pAligned

National

Leadership

Modern Workforce

Exploit Info.

Revolution

Use of Innovation

Drive Efficiency

Nursing is integral to the 5YFV

What does it mean for Nursing?

Focusing on prevention

Empowering patients

Engaging communities

• Incentivise healthier individual behaviours

• Strengthen powers for Local Authorities

• Targeted prevention programmes – starting with diabetes

• Additional support people to get and stay in employment

• Create healthier workplaces – starting with the NHS

• Staff as role models

• Staff as expert in behaviour change

• Improve information: personal access to integrated records

• Invest in self- management

• Support patient choice

• Increase patient control including through Integrated Personal Commissioning (IPC)

• New relationships

• Sharing the leadership space with patients

• Support England’s 5.5m carers – particularly the vulnerable

• Supporting the development of new volunteering programmes

• Finding new ways to engage and commission the voluntary sector

• NHS reflecting local diversity as an employer

GP NursesCompetent, confident nurses for the 21st Century Practice Setting.

Making Room in the Clinic….Modern health care depends upon:

Nurses, physicians, and patients working together

finding common ground

putting patients first

knowing how to use the skills and knowledge of providers across time and place

Clinically significant questions focused on health policy issues :

How do we decide who provides particular types of care at particular times and places?

NY VNA, circa 1900, VNA Coll.

“nurses…particularly effective at improvisation, invention….”

What do PNs do?

“Patient Centered” Assessment Diagnosis Treatment Case Management/coordination of care/integration Continuity and secure transmission across the

health system Emotional support Access “Whole Person”…Family and Community focus

PN Managed Clinics

History of nurses managing health care independently and interdependently:

– In home during child birth and plagues– In wars caring for the soldiers – In public/community health during

epidemics

Some of the challenges for PNs• Care need is changing more quickly than workforce

development producing huge capacity and capability pressures

• Models of practice are very variable;• Availability of specialist practice and leadership education

and training is decreasing;• Profile of DN & PN is low• Young people are not given adequate careers advice • Undergraduate student nurses can’t access placements

easily • Qualified nurses often use DN & PN post as a default

position • Historical education commissioning methods• Ageing workforce• Indemnity

Limitations to PN progression

Scope of practice Payment Competition vs..

Collaboration Nursing & Midwifery

Council Autonomy Prescriptive authority

Some of the challenges for PNs• Care need is changing more quickly than workforce

development producing huge capacity and capability pressures

• Models of practice are very variable;• Availability of specialist practice and leadership education

and training is decreasing;• Profile of DN & PN is low• Young people are not given adequate careers advice • Undergraduate student nurses can’t access placements

easily • Qualified nurses often use DN & PN post as a default

position • Historical education commissioning methods• Ageing workforce• Indemnity

Transforming Nursing for Community and Primary Care

Revalidation for nurses Accountable clinician Compassion in Practice/ 6Cs Supporting New Care Models CQC inspection of general practice Workforce review

All the above programmes have or will have a focus on community and primary care nursing

Nursing contribution to strengthening Primary Care

Focus on developing more general practice, district and community nurses to:•Play an enhanced role in the community•Enable healthy lives and managing self- care•Enable whole-person coordinated care

Addition of a community care field to encourage more nurses to see specialised community care as a future career - field could include district nurses, GP practice nurses, health visitors and school nurses

Develop more practice placements in primary care

What about the new NMC Code?

Revised Code comes into force from 31 March 2015

Contains the professional standards that all registered nurses and midwives must uphold

The Code will be central to revalidation process as a focus for professional reflection

What is revalidation?

• From 31 December 2015 Revalidation will be the process by which all registered nurses and midwives will demonstrate to the NMC that they continue to remain fit to practice

• Revalidation will take place every three years at the point of renewal of registration and will replace the existing Prep standards

• To revalidate, registrants must declare that they have met a number of requirements over the three year period

• Every year the NMC will select a sample of nurses and midwives to audit

What are the revalidation requirements?

Minimum 450 hours practice over three years Minimum 40 hours of CPD, 20 of which ‘participatory’ Obtain at least 5 pieces of practice-related feedback Record at least 5 written reflections on feedback, CPD

and/or the Code and discuss these with another NMC registrant

Have an indemnity arrangement in place Confirm your good health and character Obtain confirmation from an appropriate third party

that you have met the revalidation requirements

Revised Code: key areas of change

Current developments

Response to HEE Primary care workforce commission call for evidenceRCN/RCGP statement on principles for primary careLaunch of GPN Career Framework  Primary care themes within the RCN response to the Five Year Forward ViewPrimary care themes within the RCN response to the State of Caring RecommendationsCQC GPNurse inspection regimeRevision of GPN toolkitProduction of HCA toolkit

So change is on its way…?

I’m all for progress—

It’s change that I can’t stand…

Mark Twain