Dr Mary Malone

Director of the Oxford School of Nursing and Midwifery

What can Universities offer General

Practice Nursing

Osler Lecture (Title slide)

I aim to answer three questions :

1. What is the role of Universities nurse education

2. What are the challenges and opportunities for

General Practice Nursing in our current health and

social care system?

3. What should and do Universities offer General

Practice Nurses

EMBRACING THE ART

AND SCIENCE OF NURSING

Florence Nightingale

commonly credited as first

nursing theorist and

founder of modern

nursing. (Snowden et al 2014)

NIGHTINGALE THE CLINICIAN

NIGHTINGALE THE ACADEMIC

NURSE TRAINING

& DEVELOPMENT

Professionalisation

of trained nurses

Nursing academic

elite

Nurse Training

Democratization

of nurse education

1800 1900 1950 2000 2019

2019

A New Perspective for a

New Environment

New Perspective : Educating nurses to work

beyond the acute environment, with a non-

differentiated population group with multiple and

varied health needs:

• 2014 : Five Year Forward View

• 2017 : Delivery Plan for the Five Year Forward

View

• 2015 – 2021: Sustainability and Transformation

Plans

• Oxford Federation for General Practice and

Primary Care

What is General Practice Nursing ?

The work of the General Practice Nurse

• Consultation skills

• Public health and an introduction to health screening

• Cervical cytology

• Women s health Men s health Immunisation

• Travel health

• General principles of long-term conditions Diabetes Respiratory conditions

• Chronic kidney disease

• Coronary heart disease

• Cancer as a long-term condition

• Dementia Mental illness as a long-term condition

• Decision Making

• Referral

• Leadership and management

Who are General Practice Nurses ?

The RCN Cross sectional survey of 2006 found a positive picture

• General Practice Nurses were an experienced group (averaging 26 years

of experience rather than 17)

• Were less likely to be degree holders (only 17% had degrees whereas 33%

of other nurses had degrees)

• Were described as highly satisfied with their work

• Were described as enjoying their work environment

• Managed increasingly complicated health needs and were identified as

delivering as high quality care as GPs (Sibbald, 2008)

• Increased staffing levels of general practice nurses were associated with

improved practice performance in chronic disease management (Griffiths,

Maben and Murrells, 2011)

Who are General Practice Nurses in

2016

2016 Survey by the Queen’s Nursing Institute found that :

• 3.400 nurses in general practice across the UK

•

• 33.4 due to retire by 2020

• 2% men

• 53% said the employer always supports requests for professional

development

• 10.6% held the Specialist Practitioner qualification

• 22.8% had two jobs

• 32.6% work evenings and 38% do home visits

• 43.1% said the skills and qualifications within their team could be enhanced

in order to provide better patient care

General Practice Nursing :

Skills delivered from a new perspective

• Responding to the challenges of promoting health and treating chronic

illness for a population of 224.000 people

• A population characterised by diversity : from students to frail elderly

• Who need medical and nursing attention delivered with speed and outside

of the hospital environment (urgent access hubs)

• Whose care needs span both health and social care and may also involve

work with the voluntary sector

• Who may be engaged with other workers, like Practice Link Workers, who

are supporting activities intended to promote health and wellbeing

Some thoughts moving forward

• General Practice, primary care and community services are at the

vanguard of delivery for modern health care – but the demand is increasing

in volume and in complexity

• We need a more granular analysis of workforce to identify the optimal skill

and educational level which can contribute to improved patient care

• The General Practice Nurse is well placed to lead the vanguard – but she

or he needs to be adequately prepared to do so and supported in the role

• We need to ask afresh : What does that support look like?

• The world has changed and our old models may not work

• We need a more granular analysis of workforce to identify the optimal skill

and educational level which can contribute to improved patient care

• We need to ask the right people – you – what would an excellent

preparation look like from your perspective. How should a career pathway

develop and work for you : taking you from pre-registration to post

qualification, to clinical academic to Chair in General Practice Nursing, to

Consultant in General Practice Nursing

OSNM - Oxford School of

Nursing and Midwifery

OxINMAHR - The Oxford

Institute of Nursing,

Midwifery

and Allied Health

Research

OUHFT - Oxford

University Hospitals NHS

Foundation Trust

OHFT - Oxford Health

NHS Foundation Trust

Using the Resources

Available to us

Our working principles

Co-existence: Where we have come from?

Co-operation: Leadership, support, transforming practice

Collaboration: Partnership working, safe space for enabling

conversations, informing our thinking, informing our action

Co-production: Joint workforce, integrated training, equal

opportunities, equal benefit

Credit: Guy’s and St Thomas’ NHS Foundation Trust

Campaign vision

To improve health globally by

raising the profile and status of

nurses worldwide.

Influencing policymakers and

supporting nurses to lead, learn and

build a global movement.

Aims by 2020

1. Influence UHC, NCD and other

policy

2. Promote and develop nurse leaders

3. Disseminate and share effective

practice

4. Create, identify and disseminate

evidence of impact

5. Invest in all aspects of nursing

The health challenges of the 21st Century

cannot be overcome without strengthening

nursing and

midwifery: nursingnow.org #NursingNow

#globalhealth

COME AND JOIN US. Let us know how you can help, share our events with others, find opportunities to

share your skills, publicise what you are doing, connect with nurses around the globe.

Credit: The Royal College of Nursing

OSNM Nursing Now Events

2020

FEBRUARY: Asset Mapping for

health and wellbeing –

partnership focus on a local area.

MAY: Promoting Nursing with

school children – local

experiences and discussions.

SEPTEMBER: Nursing Now

along the Lifespan – exploring

life course research and impacts CONTACT US AT:

nursingnow@brookes.ac.uk

REFERENCES

AUKUH (2012) The nurse and midwife research clinical academic: development, progress and

challenges; Annual report of activity. file:///C:/Users/ruswh/Desktop/AUKUH_The_Nurse_and_Midwife_Research_Clinical_Academic.pdf

AUKUH (2016) Transforming healthcare through clinical academic roles in nursing, midwifery

and allied health professionals; a practical resource for healthcare provider organisations.

AUKUH Clinical Academic Roles Development Group.

Bailey S. (2016) Why nurses are in a prime position to lead clinical Research. NIHRBlog https://www.nihr.ac.uk/blogs/why-nurses-are-in-a-prime-position-to-lead-clinical-research/4945

Ball J, Pike G (2009) Practice Nurses in 2009: results from the RCN annual employment surveys 2009 and

2003 (RCN, London)

BallJ, MabenJ and Griffiths P (2015)Practice Nursing : What do we know ? British Journal of General Practice

65 (630): 10-11

Biley F. (2005) Nursing redefined: emergent insights etc…

Carper B.A. (1978) Fundamental patterns of knowing in nursing. Advances in Nursing Science,

1, 13–23

Council of Deans of Health (2018) Nursing, midwifery and allied health clinical academic

research careers in the UK https://councilofdeans.org.uk/wp-content/uploads/2018/08/Nursing-midwifery-and-allied-health-clinical-

academic-research-careers-in-the-UK.pdf

REFERENCES

Griffiths P, Maben J, Murrells T (2011) Organisation and quality of staffing and quality of

chronic disease management in primary care : observational study using routinely

collected data. International Journal of Nursing Studies 48 (10) 1199 - 1210HEE (2019)

Return to Practice Nursing

https://www.hee.nhs.uk/our-work/return-practice-nursing

Huq J-L, Reay T, Chreim S (2017) Protecting the Paradox of Interprofessional Collaboration

Organization Studies Vol. 38(3-4) 513–538

Laurant M, Reeves D, Hermens R et al (2005) Substitution of doctors by Nurses in primary

care. Cochrane Database and Systematic Review 2 CD 00 1271

National Information Board. Gov.UK. Delivering the Five Year Forward View (2017). National

Information Board. NHS

NIHR (n.d.) Building a research career, NIHR, [online] available here [accessed 30 Nov 2019

https://www.nihr.ac.uk/documents/faculty/Building-a-research-career-handbook.pdf]

NMC (2019) 100 years of professional pride https://www.nmc.org.uk/always-caring-always-nursing/100-years-of-professional-pride/plain-text-timeline/

NHS England. Five Year Forward View (2014) NHS England

McKeown M and Carey L (2015) Democreatice Leadership: a charming solution for

nursing’s legitimacy crisis. Journal of Clinical Nursing, 24 (34). pp315-317.

REFERENCES

Snowden A, Donnell A, Duffy T (2014) Pioneering Theories in Nursing. Digital version.

Andrews UK, Luton

Sibbald B, Laurant MG, Reeves D (2006) Advanced nursing roles in UK Primary care. Med. J.

Aust 185 (1); 10 – 12

Sibbald B (2008) Should primary care be nurse led ? Yes. BMJ 2008 337:91157

Thomas G (2016) A Brief History of Nursing in the UK https://memoriesofnursing.uk/wp-content/uploads/A-Brief-History-of-Nursing-in-the-UK.pdf