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May 2019

Survey reveals highs and lows of general practice nursing

A new survey of more than 500 nurses working in general practice in a single region has highlighted a looming demographic crisis. About a third (32%) of respondents plan to retire within 5 years, but despite national initiatives to improve recruitment, the region faces a serious shortfall in its nursing workforce.

More than one-in-ten nurses in the Wessex LMCs region are over the age of 60, and almost half (45%) are aged 50-59.

‘We have an ageing workforce and when they leave, they will take their skills and knowledge with them,’ said Wessex LMCs nurse adviser Helene Irvine, who coordinated the survey.

The objective of the survey was to consider and make recommendations on:

  • The challenges currently facing nurse recruitment and retention of nurses in general practice
  • What nurses saw as the benefits and constraints of working in general practice
  • How to develop a culture that encourages new staff and those considering a change in career to see primary care and general practice as a great place to work.

Most of the respondents were positive or very positive about working in general practice, especially among nurses aged under 50 years, and those working as advanced nurse practitioners or nurse practitioners.

The groups most likely to hold negative or very negative views about their working environment were those in the 50-plus age groups – making it more challenging to retain them in the later stages of their careers.

Ms Irvine said: ‘They should be encouraged to stay and offer their services in a different capacity for example training and support to existing and new staff, supervision and assessing, locums, working across practices and primary care networks.’

She added: ‘Retention and recruitment of nurses is still a challenge. We need to consider how we retain these skilled and experienced staff [as well as] how to recruit more nurses.

‘We need to create an environment that encourages new staff and those considering a change in career to see primary care and general practice as great place to work.

‘It is vital that students are exposed to general practice throughout their training and have a positive experience.’

However, although the GPN 10-point plan aims to raise the profile of general practice as a career option and to increase the number of students in practice, the tariff paid to practices for student nurses in not ‘currently in line’ with other allied health professional student posts.

Only 1% of nurses in general practice in the region are male. Ms Irvine said: ‘The majority of nurses employed in general practice are female and part time. However, if we are to attract more men and students finishing university into practice is it likely that they will be looking for full time posts with career development.

‘It is important therefore to also develop portfolio careers for nurses working in general practice. Wessex LMCs are currently trying to explore ways that this could work in more detail and plan to have discussion with Universities, secondary care and other care providers.’

The report says the development of primary care networks might allow for the movement of staff between practices, and could overcome some of the issues in ‘clusters’ that have high numbers of staff retiring.

‘Primary care networks will [also] provide the opportunity for nurses to develop their skills and work in different ways,’ Ms Irvine said.

While 89% of nurses would recommend their practice as a place to work, almost as many nurses pointed out that there was a lot that practices could do to improve their working lives. The most common concerns were feeling stressed (62%) with common reasons including patient demand, workload, not enough time to complete administration tasks, understaffing and dealing with complex patients in 10-15 minute appointments.

Respondents also felt that GPs and practice staff – and patients – should have a better understanding of their roles and skills.

Other negative comments related to lack of equipment, no access to training, not feeling valued and lack of supervision.

More than half of respondents (56%) identified gaps in their competencies, skills and knowledge to undertake their role. The most common knowledge gaps were in the management of long term conditions, women’s health and contraception, mental health, paediatrics, triage and minor illnesses, leadership and management, and IT. All nurses recognised that regular updates were vital to ensure competency and safety.

Pay, terms and conditions were identified as important factors that impact on recruitment and retention by 45% of respondents, but 60% agreed they would be recognised for excellent work.

Asked what the three things would help retain nurses, respondents said:

  • Pay, terms and conditions
  • Being listened to and respected
  • Protected time to access training

The report concludes: ‘Nurses have indicated that general practice is a great place to work and have identified the key characterises of a working environment. Practices need to be made aware of what good looks like. Nurses are the bedrock of primary care their role, skills and features need to be celebrated and they are essential to the sustainability of primary care.’