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Maintaining and improving general practice nursing care for patients

Gill Rogers BA RN MSc, Director of General Practice Nursing, Londonwide LMCs.

You can also read the thoughts of Dr Crystal Oldman, Chief Executive, The Queen's Nursing Institute, on how to meet the London workforce challenge. 

During my first year of nurse training I was lucky enough to have a four week community placement in a health centre.  Four years later, at the end of the course, I returned to the same health centre where I was able to visit and see many of the same families. 

I was struck by the importance in my own training, of seeing how general practice worked first hand and where the majority of patients are looked after from cradle to grave. I now have a role in supporting General Practice Nurses (GPNs) and Healthcare Assistants (HCAs) working in general practice. 

Those that work in practice nursing know what a fantastic place it is to work. They describe it as a privilege to work with families in the primary care setting and wonderful to be able to operate as an autonomous practitioner.

Debbie Brown, Nurse Consultant in Primary Care, Lewisham says “Working as a GPN is a fantastic job, we are generalists working autonomously, and in partnership with the wider primary community team. GPNs with advanced skills have the ability to assess patients with differential undiagnosed presentations, using advanced assessment and diagnostic reasoning skills to treat or refer patients appropriately. We have full support of our GP's working in partnership complementing each other. We are the glue that holds primary care together!”

Supporting entry into general practice for GPNs and HCAs

As Crystal has highlighted, the fact is that GPNs and HCAs trained to work in general practice are in short supply. There are a number of reasons for this. In London there are few placements in general practice for undergraduate nursing students. These placements plant the seeds in the minds of nursing students who then consider working in these GP practices in the future.

It is not an easy decision for practices to take on undergraduate students. Often they are working in premises where space is at a premium and then there is also the time commitment needed to support the learner. Where there is a single GPN at a practice their time may already be fully engaged in providing direct patient care. Having students in general practice requires dedication from the whole practice team, and more crucially, support from the university where the student is hosted. Practice nurses often lack the confidence to mentor students at their practice, despite many having a huge wealth of experience in general practice and other settings prior to coming into it.

Mentors need education and ongoing support and this is an area that must be developed and funded if we are to expand the placements in general practice and make it attractive to both mentors in practices and students. A placement in general practice might be the only place that a student will have one-to-one supervision with a registered nurse as well as access to all the community services.

Valuing and increasing placements

Jacqui Hodgson Practice Nurse Educator from Barnet says “Student nurse placements in general practice are essential for the primary care teams to grow and develop into the multi-professional organisations which are essential for joined up holistic patient care.

Students have a plethora of opportunities in general practice to learn and develop not only their clinical but management skills. I see them as the linch-pin between primary and secondary care nursing in the future”.

The board of Londonwide LMCs is fully supportive of the work that we do to assist GPNs and HCAs and this is a demonstration of medical leadership supporting, investing, influencing and working to make sure that current GPNs are educated and supported as well as the workforce of the future.

Dr Adam Jenkins, Chair of Londownide LMCs Board, says: "Well trained practice staff are essential for good quality primary care. When practices nurses and HCAs attend approved training courses they are more confident in the services they provide and the whole practice benefits. I am very pleased that the courses offered by Londonwide Enterprise are so highly thought of and I the feedback I get from practices is extremely positive."

If all practices could be supportive of their wider team then the hurdles that GPNs often face could be reduced.

Educating the workforce and sharing best practice

We will continue to support practice nurses and their teams through the offer of our Health Care Assistant Blended Learning Programme (University of Middlesex accredited) and General Practice Nurse Blended Learning Programme accredited by the RCGP and the University of Middlesex. We have developed a community of practice nurse educators and are keen to develop a community of practice nurse mentors. We also offer the annual LEAD annual programme which has lots of relevant updates for GPNs and HCAs. Education is a key element of our support for them and we encourage practices to get actively involved in education.

Since 2005 Londonwide LMCs has been supporting the education and development of GPNs in London. We began with small scale network meetings which helped us hear from nurses what the issues were. At those early meetings it was about pay and conditions, lack of leadership, lack of support for practices for nurses to undertake training and development.

We support a General Practice Nurse Leads group which has members from all over London, meeting four times a year. The group supports the development of the GPN Leads through external speakers and information sharing, so that nurses in the field have a chance to hear what is going on for them. The conversation has moved on from the early days and the group now offers many more solutions, suggestions and possibilities to improve the working lives of GPNs. The dialogue is more hopeful and positive.

Our vision for 2016/17 is to  continue to work with funding bodies, NHS England London, Health Education England London, Higher Education Institutions, Royal College of Nursing, RCGP, QNI, General Practices and many more  to influence the investment in the  General Practice Nursing Team. At LLMCs we want to make a difference to the lives of GPNs and HCAs so that they are able to deliver the care patients need for the future.

Last updated : 12 May 2016

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