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Supporting transformation in primary care – A place at the table

31 January 2018 | Jenny Mooney

On a cold Thursday January evening a group of enthusiastic practice nurses, nurse practitioners and GPs came together, in an event run by UCLPartners’ Primary Care Network, to discuss how they could work together to support transformation in GP practice.

The main topic, both within the meeting and in the buzz of conversation over coffee, was:

How can nurses be attracted to come into and remain in GP practice nursing in today’s healthcare climate?

The current picture

Nursing is facing a crisis of recruitment and retention. New figures published by the Nursing and Midwifery Council show an alarming number of nurses and midwives leaving its register. Over the last year 27% more nurses left the register than joined it. Practice nursing is no exception to this. Jane Clegg, Deputy Chief Nurse for NHS England (London) explained there are 1,700 practice nurses currently working in London, with a current vacancy rate of just under 200.

Professor Martin Marshall, Primary Care Development Programme Director for UCLPartners set out the challenge for primary care. At the start of his career as a GP in Devon his practice supported 8,000 patients with three full time experienced practice nurses, including a nurse partner. Some years later, in his current practice with a patient case load of 16,000 patients, there is one practice nurse.

There are specific issues relating to practice nursing which make the challenge of recruiting and retaining nurses even more significant. Unlike nurses based in secondary care, practice nurses are not paid under the NHS standardised pay arrangements for nurses (Agenda for Change) which sets pay grades, increments and terms and conditions.  Practice nurses rates of pay and terms and conditions are set by individual practices meaning there can be variability in both their rates of pay as well as other contractual arrangements such as annual leave, sick pay, study leave and access to continuing professional development (CPD).  These issues coupled with the current falling nurse recruitment rate,  the lack of EU registrants (down by 89% last year) and the challenge of living  on a nurse’s salary in the capital highlight the urgent requirement for  new models of working  to ensure the survival of practice nursing.

A plan to take action

NHS England has released a 10 point action plan to help address some of these issues. The plan includes:

  • Increasing the profile of practice nursing
  • Extending leadership roles
  • Improving access to education
  • Extending the number of pre-registration placements and return to practice programmes
  • Improving retention, including creating of a model employment contract
  • Developing healthcare support workers and associate career pathways
  • Increasing the focus on disease prevention

Learning from Tower Hamlets

Vicky Souster, Education and Development Manager for Tower Hamlets General Practice Care Group, described the very successful ‘Open Doors’ programme to recruit and train new practice nurses. These posts are aligned in terms of pay and conditions to standard NHS Agenda for Change contracts and offer a two-year degree or post graduate diploma in primary care nursing. The total cost for a Clinical Commissioning Groups to train seven practice nurses through this programme is £67,781. Retention to date has been 100%.

Looking forward

The evening highlighted a real desire for change; and a challenge to practice nurses to step up and make their voices heard in terms of celebrating the huge value they bring to the delivery of primary care, as well as ensuring they articulate the need for fair and equitable terms and conditions of work and pay.  There was a commitment made to take the issues of a standardised practice nurse contract and practice nurse graduate training back to the NHS England General Practice Nursing Delivery Board and Health Education England Local Workforce Action Board.

So will practice nursing survive?……as one nurse said in the break, “I couldn’t have asked for a better career. Practice nursing uniquely offers autonomy of practice, an opportunity to support preventative care and the management of both acute and chronic illness within a multidisciplinary team.  We just need to make sure we have a place at the table to help influence the future direction of primary care.’’