Supporting the Development of the General Practice Nursing Role in England

Fiona Cook BA (hons) RGN PgCEPractice Nurse Team Leader and General Practice Lead, Plymouth University

General Practice Nursing in England

• Arose originally in response to the needs of General Practice

• Has continued to develop and change with each successive transformation of General Practice

• Rapidly expanding workforce until very recently

The Roots of General Practice Nursing

1969 Secretary/Receptionist/Nurse

1970 s The attachment of Community Nurses to surgeries to serve the practice population

1980s Focus on Health Promotion / Additional income attached to screening targets

• By 1980 Medical Research Council identified the need to examine the role of this increasing cohort of nurses and found that :

• Considerable variety• Extended roles• Valued for role with women in a world of

predominantly male GPs

• RCN published ‘Standards of Care for General Practice Nurses’

“The only constant is change”

• The National Health Service ‘free at the point of use’

Recurrent themes of legislative changes

• Successive attempts to address health inequalities (the so called ‘postcode lottery’)

• Increased emphasis on preventative strategies

• The devolution of health care from hospitals to General Practice

Initiatives which have led to the rapid expansion of GP and the GPN role

1977 -1500 PNs

1984 – 3,891

1990 – 13,280

1997 – 18,389

2005 – 22,904

Movement from

• Dependence to Autonomy• Passive to Active• Subjective (traditions) to Evidence Based

Practice

• With an identifiable career pathway and many different opportunities to develop in practice

Career Framework forGeneral Practice Nursing

Working in Partnership Programme 2004

“we will need to handover a lot of our care to our nurses”

Professor Steve Field

Crucially

• No standardised training for the GPN in England

‘More lives will be saved in future in general practice than in hospitals as the power of family doctors to intervene on behalf of patients increases.‘

The roots of our unit – recognising the need for structured GPN training

Prof Sir Dennis Pereira-Gray (Institute of General Practice, University of Exeter)

From small beginnings....• GPs and GPNs trained together to design and

deliver courses for local nurses

• Certificate in GPN • Advanced Nurse Practitioner Programme

• Snowball effect as many of the local GPN workforce completed the training, then went on to train as educators and help deliver quality education to others

...Great opportunitiesFoundations of General Practice Nursing

• 42 experienced GPNs /trained educators who do and teach!

• A 6 month foundation programme accredited at degree level combining taught clinical topics with a mentor in practice to support the development of nurses new to general practice

• Covering core competencies for an entry level General Practice Nurse

• Completion of a Practice Competency Document to evidence assessment and Academic Portfolio of learning

• 9 years and 18 cohorts of students later, with no central funding we have 19 students who commenced the course last week,

• With a team working ‘ on the coal face’ and with considerable up to date clinical expertise comes the ability to develop training responsively to meet the needs of an ever changing arena

• Additional Modules in Respiratory Care, Cardiovascular, Minor Illness, Sexual Health and more in development...

• A reputation which has travelled

What we have learned• countrywide provision of training for GPNs very patchy and

therefore continuing gaps and worrying variety in standards of care

• The Royal College of General Practice Foundation has commissioned us to write competencies for entry level GPNs

• Care Quality Commission will be looking for evidence that GPNsHave been trained to this standard

Other interested stakeholders

• Local Deaneries (Organisation who oversee GP training)

• The emerging GP Consortia who will take on the commissioning of Health Care from the Primary Care Teams

• Nursing and Midwifery Council

The Rise of The Health Care Assistant

HealthcareSupport WorkerRole DescriptorsFrom WIPP 2006

The Rise of the HCA

We are working on

• Foundations of General Practice for Health Care Assistants in development

Thank you for Listening

Any Questions?