How and why GPs should cherish and value their practice nurses

The GP who headed up the GPN workforce development review has some important messages for his colleagues that you can share with your employers if you are feeling undervalued

By rights, this article should not be appearing in Practice Nurse, but in one of the GP publications. Its key message is that GPs undervalue their general practice nurses at their peril. The author often says to GPs that it is ‘not a shortage of doctors, but losing your practice nurses that will break you!’

There is no doubt that strong general practice nursing teams are vital to delivering the high quality care our populations both need and deserve. You have made chronic disease management your own and it is now often the highly skilled GPNs who are the experts in chronic disease management rather than GPs. As a practising GP myself I happily put my hand up to being de-skilled, particularly in diabetes and COPD management, but have great confidence in our nurse team and often defer to them for advice and help with management planning. In general practice we have moved a long way but we must get better at embracing GPNs as the highly skilled, hard working clinical professionals that they are, and we must develop a better culture of respect and collaboration rather than the redundant hierarchical structure where ‘Doctor knows best!’ Believe me…he or she often doesn’t! We must accept that targets to increase the number of GPs are unlikely to be reached, and that the biggest workforce risk is that senior GPNs will retire and there will simply not be enough nurses to replace them. Already hard-pressed GPs will be forced to take back chronic disease management to maintain safety, and some practices will just not remain sustainable.

AGEING WORKFORCE

At long last, multiple sources are recognising that we not only have a GP shortage but have a growing shortage of GPNs and it’s very likely to get worse. General practice nursing is described as an ageing population – not a very flattering description but one that recognises that, compared with other groups in primary care – including GPs – GPNs have a higher proportion over 45 years of age. This is largely due to the current GPN population being made up largely of nurses who chose general practice nursing as a second career.

It’s great that now we are seeing a slow but sure increase in the number of newly qualified nurses wanting to join general practice on qualification, brought about largely by the efforts of training hubs across the country to grow the number of student nurse placements. From my experience leading the Advanced Training Practice Scheme in HEE Yorkshire and the Humber we are at last seeing a significant rise in the number of GPNs under 35 (an increase from 8% to 12%, up by 50% since we started collecting data from practices). Through schemes such as the GPN Ready Scheme and HCA apprenticeship we are starting to really influence GPs’ attitudes to employing new staff.

WORKFORCE DEVELOPMENT

NHS England has recently launched the GPN Ten Point Action Plan (TPAP) in a response to recommendations in the GPN Workforce Development plan. The national training hub network is gaining traction across the country to help deliver the TPAP objectives and the Department of Health has pledged to fund more training places for nurses.

So all is well… or is it?

The recently released Ipsos MORI report on general practice nursing¹ paints quite a variable picture of GPNs’ perceptions and concerns about their careers. I’ll summarise some of them below and let’s see if they resonate with you.

• Lone working and isolation
• Lack of training and support
• Variable non-standardised pay
• Increasing workload
• Variation in approach of employers
• Increasing responsibility – not always with financial recognition
• Lack of formal career pathway

This has led many GPNs to feel undervalued, forgotten, and professionally isolated.

This all sounds rather negative so lets take a different approach now and see if we can describe the factors that would make a GPN feel valued in their role.

A simple definition of ‘value’ in this context is ‘the importance, worth, or usefulness of someone’(Oxford dictionary). This might be exemplified by:

• Feeling part of a wider team – a culture of collaborative working
• Practice culture that encourages giving and receiving praise
• Feeling involved and that you are contributing to the practices success
• Being encouraged to offer opinions/ideas and being included in appropriate decision-making
• Supportive GPs who are willing to facilitate access to training and offer appropriate supervision
• Identified mentor/supervisor/buddy
• Clear contract with standardised pay adhering to career framework
• Sustainable workload and support making safe working a priority
• Supportive practice manager and team with annual appraisal and support for career development plan
• Protected time for learning/keeping up to date and revalidation preparation
• Adequate breaks in the day – not expected to work non-stop all day

I am sure other areas could be added and I am aware that there are practices who already work really hard to support their GPNs. The risk for practices is that if their staff feel undervalued they are more likely to leave. It’s as simple as that.

EMERGING ROLES

Many practices still have the habit of advertising for the same level of nurse they are losing and so are likely to try and poach nurses from other practices. With a diminishing pool of experienced nurses this is often leading to failure to replace and puts greater stresses on the remaining team.

As we move forwards, practices will be embracing more and more new roles and there will be more new learners than ever in practices. Let us remember that the GPN workforce is second only to GPs in numbers. There are many new roles emerging, such as physicians associates, clinical pharmacists, nurse associates, medical assistants and care navigators and, yes, we should be embracing and supporting their development, but they will not be able to replace at scale the critical engine room of chronic disease management that GPNs have made their own. There is currently around one full time GPN per 3,000 patients across the country, but a massive variation from practice to practice. Woe betide the practice that only recognises the value of their GPN once they have left!

So as GPNs you are such a critical part of the future.

HELP YOURSELF

Reflect on whether you feel valued in your role and explore ways you could influence your practices to improve. From my ATPS experience I am recognising more and more what superb educators GPNs can be. Be proud of being the role models your younger learners see you as and help your practice become a great environment for education at all levels. If you are near retirement, do your best to discuss succession planning before you leave so that all your hard work is left in good hands. You will have an enviable skill set. Do everything you can to ensure planning is in place so that all that wealth of skill, wisdom and experience doesn’t just leave with you.

For those of you mid career, have you considered your next steps in career development and how they might best be facilitated? Can you describe the added-value you would be able to offer your practice and its patients? Consider developing your educational skills, keep your mentorship up-to-date, and maybe look at developing a broader leadership role locally.

For those embarking on new careers in general practice, do your best not to become isolated. Push for the training and supervision you need to grow in confidence and effectiveness. If there is no senior nurse available in your practice use nurse forums, peer groups, approach nurses from other practices, or ask your nearest training hub for support.

If you are a student nurse considering general practice nursing then it is a fabulous choice for a long and fruitful career, and with great opportunities for professional development. Identify your role models and don’t be frightened. You are joining a community of fabulous dedicated nurses who really care for their patients – they will look after you and help you grow.

The NHS has huge challenges but I continue to be so impressed and overwhelmed by the quality and dedication of GPNs to their practices and their patients. You are awesome!

Let’s really make a noise about General Practice Nursing – the far too hidden jewel in the crown of amazing patient care.

• Dr Pete Lane is the Clinical lead of the Advanced Training Practice Scheme with eight training hubs supporting workforce development, and 30% of all practices in the region are currently engaging in student nurse training. The scheme also runs a GPN Ready Scheme for newly qualified nurses, a HCA apprenticeship scheme, supports mentor/sign off mentor development and supports increasing numbers of Advanced Clinical Practitioner roles in general practice. He was also chair of the Health Education England group that produced the General Practice Nursing Workforce Development Plan in March 2017, and will be presenting on these issues at the Best Practice in Nursing conference, 18–19 October 2017, at the NEC, Birmingham.

REFERENCES

1. Ipsos MORI. The recruitment, retention and return of nurses to general practice nursing in England. August 2016 (published 27 July 2017). https://www.england.nhs.uk/publication/the-recruitment-retention-and-return-of-nurses-to-general-practice-nursing-in-england/