Exploring career opportunities in general practice nursing

Despite increases in the number of full-time equivalent general practice nurses, GPNs remain in short supply – creating a range of opportunities for those who want to progress their careers

Practice nursing has always stood apart from other roles in the profession thanks to not only the generalist breadth of work, but also the disparate advanced skills required of professionals working in this field. However, as the scope of nursing practice continues to evolve, so too do the career opportunities available in this area.

Ongoing changes to care delivery are creating new avenues for advancement, and ambitious nurses are maximising these to create new and exciting career paths which can lead straight to the top of practice management.

This rise of nurse-led practice is a relatively new phenomenon. NHS restructuring, coupled with GP shortages, mean that nursing professionals are now taking a significantly greater role in the delivery of patient care in GP surgeries and beyond. The emergence of nurse-led alternative provider of medical services (APMS) models is one aspect of this changing landscape. But, even in more traditionally structured surgeries, responsibilities which were once the preserve of doctors – such as diagnosis, prescribing drugs and referring patients – are now increasingly being shared with nursing teams.

Speaking at a Commons select committee on the nurse workforce late last year, Chief Executive of NHS Employers, Danny Mortimer admitted that the widely reported drop in overall nurse numbers may have been impacted by more nurses moving on to become advanced nurse practitioners (ANPs): a change that NHS Employers ‘did not anticipate’. He also conceded that his team had ‘failed to anticipate the growth of the advanced nurse practitioner role, and the demand for nurses operating in an extended role’.

Clearly, for existing or aspiring practice nurses looking to upskill themselves with a view to either promotion within their current practice, or finding a new role elsewhere, there has never been a better time to explore their options.

This shifting tide is underlined by the fact that official NHS data published last month found that the number of full-time equivalent (FTE) GP partners in England fell by 708 (3%) in 2017, and by a further 0.3% by March 2018.¹ Meanwhile, over the period from September 2015 to March 2018, overall FTE nurse numbers in general practice grew by around 400 to 15,889, an increase of 2.3% since March 2017. NHS Digital attributes this rise to an ongoing growth in numbers of nurse practitioners and practice nurses with 'extended roles'.

Those already working in practice will be familiar with the many facets of the occupation – from immunisation to paediatrics – and how these contribute to the job satisfaction that those working in this area often report. However, the scale of the role means that ongoing CPD is arguably even more crucial than it may be in general nursing, as practitioners build and update the skills necessary to manage the diversity of care required of them – even when not working in ‘advanced’ roles.

Historically, professionals who moved into practice nursing often had strong community or district nursing experience or were former health visitors. Nurses with extensive experience in areas such as wound care or diabetes were also seen to be a natural fit. Today, while the role is still not universally perceived as a position that a newly qualified nurse can do, given current demand, Health Education England is working to actively raise the profile of general practice nursing and to increase the uptake of the role as a ‘first-destination career’.

To move into practice nursing in the first instance, professionals will have had to have undertaken further training, such as a Postgraduate certificate in General Practice nursing, or be willing to do so once in-post. However, looking beyond technical specifications, nurses should look for career opportunities with employers which offer the right cultural fit and the ability and impetus to facilitate their long-term career goals.

Just a few short years ago, some practice nurses chose to work on a self-employed basis, but relatively recent changes to rules around off-payroll working in the private sector mean that the role now falls ‘inside’ IR35 legislation, and so there is now little incentive to work within this employment model.

This regulatory change, coupled with increasing demand for practice nurses, means that the market has swung towards permanent roles, and jobseekers should target their search and format their CVs to reflect this.

It is also worth noting that, for those looking outside of their existing practice for their next step on the career ladder, exploring opportunities outside of the public sector may be an option. The rise of private organisations, such as Virgin Care, managing community services is creating opportunities to deliver NHS care which are not promoted within the NHS itself. More traditional private sector opportunities can also offer extremely rewarding career moves.

As Practice Nurse, Una Jefford, who is based at the London Dermatology Centre, points out, ‘Leaving a large team of surgical nurses to become the practice nurse of a dermatology clinic was initially very daunting: a big step into a whole new environment. Six years on, I can honestly say it was the best decision I’ve ever made. I love sharing each patient’s journey from start to finish, managing their expectations, encouraging during the lows and celebrating the highs. One thing I love about being a practice nurse is knowing each patient individually, which enables strategies to think outside the box with regards to patient compliance and success rates.’

Looking forward, practice nurses should regularly review their long-team career goals and what steps they should take to attain them. Professionals often aspire to progress to more senior roles, such as ‘senior practice nurse’ or ‘advanced nurse practitioner’ positions, which may require additional qualifications. A well-chosen employer may help to arrange – and pay for – the training and development required, although ambitious nurses are increasingly taking control of their own destiny by funding their own study.

The ambiguity surrounding the definition of ‘advanced nurse practitioner’ status has created confusion in the past, and some experts continue to flag the ‘major’ safety fears over a lack of formal regulation for advanced nurse roles.²

While the professional standards of practice and behaviour contained within the NMC Code apply to the ANP role, not least the section on ‘recognising and working within the limits of competence’, there are currently no national standards set by the Nursing and Midwifery Council for professionals working at this level. As the Care Quality Commission outlines, ANPs must be Registered Nurses with the NMC and must also register any prescribing qualifications with them. However, as the ANP qualification itself is not recorded on the NMC register for the individual nurse, in theory, anyone can call themselves an ANP. As the Royal College of Nursing (RCN) points out, the term ‘advanced level practice’ has been applied inconsistently to a number of different roles and this has often led to confusion about the scope and competence required at this level of practice. In response, a credentialing programme for nurses working at an advanced level of practice is being rolled out across the country by the membership organisation.³

For practice nurses considering stepping up into an ‘advanced’ role, this new voluntary system of quality assurance can be applied to assess the background and legitimacy of professionals to practice at an advanced level through reviewing not only their qualifications, but also their experience and competence. It allows nurses to gain formal recognition of their expertise and skills in clinical practice, in a way that is recognisable to colleagues, employers and the public.

The RNC’s position statement outlines the benchmark for advanced level nursing which applies to all clinical nurses working at an advanced level regardless of area of practice, setting or client group, which it stresses should be viewed as a minimum threshold. It comprises of 28 elements which include: the ability to practise autonomously, use their professional judgement in managing complex and unpredictable care events as well as use financial acumen in decision making.

As the Department of Health attests this methodology can enable stakeholders to use to make informed judgements regarding the required scope, level of practice and associated competence of nurses working at advanced level. It also allows professionals to determine where they may need to upskill to accelerate their career.

The RCN recognises the value of a first-level honours degree education and the important contribution that many of the pioneering ANPs have made and continue to do. The original nurses working at an advanced level were called nurse practitioners, and currently the RCN’s position is that any nurse who has been educationally prepared – whether at BSc or MSc level – against the RCN competences, is entitled to be referred to as an ANP. The exception is those working in Wales, where an MSc is required.

However, there is a general consensus that, today, a master’s qualification is the most robust way to enter advanced practice. Accredited programmes, such as the MSc in Advanced Practice in Health and Social Care, or the MSc in General Practice Advanced Nurse Practitioner, which are equivalent to a Level 6–7, usually take around two years to complete part time and cost between £3,000 and £5,000 a year. In order to be eligible to study at this level, students must have two years’ clinical experience, as well as confirmation from their employer of its commitment and capacity to support the nurse’s practice learning towards an advanced role. These criteria remain the same regardless of who is footing the bill for the training, and is certainly something for professionals to keep in mind when choosing an employer which will aid future career development.

For nurses who are already working in extended roles and who wish to add another string to their bow, becoming qualified to prescribe is a logical next step which can boost career prospects significantly. There are two levels of nurse prescribers: Community Practitioner Nurse Prescribers (CPNP) – who have completed the NMC v100 or V150 course – become qualified to prescribe only from the Nurse Prescribers Formulary (NPF) for Community Practitioners, which contains dressings, pharmacy, general sales list, as well as thirteen prescription only medicines.

Those who have successfully completed an NMC Independent Nurse Prescribing Course (also known as v200 or v300 courses), meanwhile, are able to prescribe any medicine provided it is in their competency to do so. This includes medicines and products listed in the BNF, unlicensed medicines and all controlled drugs in schedules 2 to 5. This is a four month course which costs around £2,000 and results in a Practice Certificate in Independent Prescribing: an increasingly sought-after qualification in practice nurses.

Looking forward, apprenticeship training standards have been approved for advanced clinical practitioners, meaning that in the not too distant future, practice nurses will be able to step up the career ladder without the upheaval and expense traditionally associated with a university course. In the original draft standards, which were published last year, it was revealed that trainees will be taught at master’s level and the qualification will include prescribing. The apprenticeship standard is now ready for delivery.

As the ethos of care delivery continues to adapt to address contemporary challenges, there will be a heightened need for highly skilled nursing professionals to take the lead on patient care, and, consequently, an increase in available career paths.

When it comes to future professional development, this is an exciting time for practice nurses. As the advent of nurse-led APMS providers – where nurses are surgery partners who employ doctors – demonstrates, the sky really is the limit.

REFERENCES

1. NHS Digital. General and Personal Medical Services England, March 2018 final and June 2018 provisional, 23 August 2018

2. Nursing Times. ‘Major’ safety fears over lack of formal regulation for advanced nurse roles. Nursing Times, 26 September 2017.

3. RCN. Credentialing: Recognising advanced level practice in nursing, 2017.