Making the transition into general practice nursing
This year Practice Nurse will be taking a closer look at topics that will be of particular interest to nurses new to general practice, or considering the move to general practice nursing – so if you know of a nurse who is interested in primary care, pass it on! We start the series with a guide to making the transition from the secondary care sector
In 2013 Health Education England (HEE) stated that its aim was to ensure ‘the right numbers of staff, with the right skills and right behaviours, when and wherever they are needed’ and highlighted the primary care workforce as one of its priority areas for development.1 It is accepted that there are insufficient numbers of staff working in primary care to meet demand, especially with the shift towards more health care being provided in primary care, as outlined in the Five Year Forward View.2
As well as the increased demand in primary care there is an ageing nursing workforce in general practice. In 2012 a survey by the Royal College of Nursing (RCN) found that only 2% of general practice nurses (GPNs) were under 40 years old and that 56% were over 50 years old.3 More recently, The Queen’s Nursing Institute (QNI) published a report that found that a third of GPNs are due to retire by 2020.4 The General Practice Forward View published in April 2016 set out the plans for developing and supporting general practice.5 It targets funds at the general practice nursing workforce to support recruitment, retention and training over the next five years. There are a wealth of initiatives around the country trying to address these workforce issues such as the Essex Primary Care Inter-Professional Centre for Workforce Development and The Primary Care Development Centre.6,7
WHAT IS GENERAL PRACTICE NURSING?
General practice nursing is a growing area of nursing – both in terms of the demand for increased workforce and also in regard to the scope of the role. Initially GPNs performed fundamental nursing duties such as taking observations, urine testing, wound care and taking blood but the role has expanded enormously with nurses in general practice taking responsibility for a much wider remit (Box 1).
Nurses working in general practice tend to work more autonomously than nurses in secondary care. While some nurses enjoy this, others may feel they are working in isolation and may miss the direct support of the nursing team found on a hospital ward. However, nurses working in general practice can find peer support from the wider multidisciplinary team they work in, which includes doctors, health care assistants, physician associates, assistant practitioners, pharmacists, community nurses, health visitors, practice managers and clerical staff.
GPNs are usually generalists and have a wide range of clinical skills but there are opportunities to specialise in certain areas such as long term conditions or to develop advanced nursing skills and become nurse practitioners. GPNs provide holistic care to patients of all ages, from babies to the elderly, and work closely with the patient and their family providing continuity of care. Not all patients presenting in general practice are unwell; much of the role involves health promotion and education as well as screening and health checks.
WHY CHOOSE GENERAL PRACTICE NURSING?
The QNI report on general practice nursing found that nurses like the flexibility, challenge and variety of nursing in general practice.4 Flexible working patterns, fewer unsocial hours and possibly working closer to home can improve work-life balance and help manage other commitments such as family or caring responsibilities. A practice nurse from Essex made the transition from working in a private hospital to general practice nursing. She admits she ‘had preconceived ideas of the practice nurse role which were soon changed’. She had previously ‘thought the role would be more procedure based’ but once in post found ‘you can take this role and make it your own speciality’.
Latest information from the Health and Social Care Information Centre suggests that approximately 65% of GPNs work less than 28 hours per week.8 Nearly a quarter of GPNs (23.1%) have more than one job.4 This demonstrates the flexible nature of general practice nursing. It is possible to have a portfolio career, enabling a more varied work life. For example, alongside the generalist role of the GPN the nurse can also have a specialist nurse role, work in an out of hours service, teach, have a strategic role, work in secondary care, do voluntary work or even a non-nursing role.
If student nurses are exposed to primary care during their training they are more likely to consider general practice nursing as a career destination upon qualification.9 However, placements in general practice are not always included in nurse training so student nurses interested in general practice nursing may need to request placements in general practice.
APPLYING FOR A GPN POST
Despite the workforce pressures in general practice it can be difficult to get into general practice nursing as often GP practices want experienced GPNs and advertise for nurses who can manage long term conditions, perform cervical cytology and ear irrigation as well as having experience of childhood and travel immunisations. This is due to a variety of reasons – access to training, the cost of training, the time it takes to get experience and, in some areas, a lack of suitably qualified mentors/preceptors.
Without a GPN post it can be difficult to get the necessary practical experience and competencies or even attend the relevant training courses, as they often require a period of mentorship after the theoretical training. Newly qualified nurses (NQN) also find it difficult if they have not had any placements in general practice as part of their nurse training despite the fact that there is evidence that, with appropriate support, NQNs can go straight into general practice nursing without secondary care experience.9
When a GPN post is advertised it can be useful for applicants to contact the practice manager or lead nurse at the practice to have an informal discussion and ascertain the key skills that are required for the role. This can vary depending on the needs of the practice population. For example in an area with a high elderly population there will be less demand for cervical cytology screening and childhood immunisations but greater need for skills in the management of long term conditions such as diabetes and heart disease. Not all GPNs have all the skills to do everything that falls in the general practice nursing remit and sometimes practices are trying to replace certain key skills, e.g. asthma management. Some practices are quite small so choosing the right person to fit in with the existing team is often more important that choosing the candidate with all the skills and competencies as these can be acquired with training and experience.
The QNI surveyed GPNs to discover where they had worked prior to becoming a GPN and found that they came from all nursing backgrounds, both in the community setting and secondary care.4 This is because general practice nursing is so diverse that virtually all previous experience is relevant and transferable. It is important when trying to make the transition into general practice nursing that nurses update their CVs to highlight their transferable skills, i.e. the skills and experience that are relevant to general practice nursing. For example, a nurse with experience in Emergency departments may have skills in minor illness and minor injury management, triage, wound care, management of long term conditions, ECG interpretation, mental health and time management under pressure. All these are relevant in primary care. It is useful for nurses to benchmark themselves against the most needed skills for general practice nursing identified in the QNI audit,4 when applying for a post and highlight these on their CV and application (Box 2). There is a useful example of using a SWOT analysis to facilitate this on the QNI online resource ‘Transition to General Practice Nursing.’10
It is useful to access local GPN support groups and social media forums such as WeGPNs to get an idea of what the current issues in general practice nursing are. The RCN General Practice Nursing Forum has a Facebook group for members, which discusses issues relevant to general practice nursing and provides a support network for GPNs. These support networks are also very useful following the transition into general practice nursing as they are an invaluable source of relevant information and support.
THE INTERVIEW FOR A GPN POST
The practice will be looking for someone who is enthusiastic as well as committed to general practice nursing and ongoing professional development. It is important to be aware of the current issues relevant to general practice such as the Five Year Forward View.2 It is also helpful to have an understanding of the principles of the Quality Outcomes Framework, as it has a significant role in general practice as a driver to improve the quality of health outcomes for patients and also as a mechanism by which practices generate part of their income. It is useful to find out as much information as possible about the practice before the interview, although there should be an opportunity to find out more detail at the interview.
At the interview, candidates may be asked why they want to become a GPN, what they have to offer the nursing team or what aspirations they have for their future career. The interview is also a chance to find out what development and support opportunities are offered e.g. is there access to training and development, is there funding for the training, do they provide an induction programme or period of preceptorship?
It is important to be aware that terms and conditions vary from practice to practice as most GP practices are independent contractors to the NHS and do not necessarily have to follow NHS Agenda for Change terms and conditions on pay scales, sick pay, annual leave and study leave. This may necessitate the need to negotiate terms and conditions. The document ‘Nurses employed by GPs: RCN guidance on good employment practice’ can be useful to help with these discussions.11 The document ‘Updated GPN Nursing Standards’ from the Royal College of General Practitioners (RCGP) General Practice Foundation also provides guidance on clinical, professional and employment practice issues, indicating what is expected from the GPN and the employing practice.12
NEW IN POST AS GPN
There is a need for appropriate support and development opportunities for both experienced nurses who want to make the transition into general practice nursing and newly qualified nurses who want to start their nursing career in general practice. NQNs do not need to have secondary care experience before they can work in general practice. With the right level of support and preceptorship, they can be a vibrant and exciting addition to the general practice nursing team.
Both NQNs and nurses new to working in primary care will benefit from a period of preceptorship to facilitate the transfer into their new role. This enables the nurse to consolidate their learning and current knowledge and skills and to acclimatise to working in a more autonomous role. It is expected that this period of preceptorship will last at least four months but this will depend on individual need. A preceptor should have at least a year’s experience as a general practice nurse and be able to demonstrate that they have excellent clinical skills and professional values so they can be a role model for the junior or less experienced nurse. They must also have excellent communication skills and be empathetic to the needs of the nurse during this transition phase.13
To facilitate the transition into general practice nursing and the acquisition of new skills the RCGP has developed a competency document* for GPNs.14 There is also a useful competency document which was developed by Derby and Derbyshire Local Medical Committee and Health Education East Midlands.15 These frameworks ensure that a level of competency is achieved across the generalist role of the GPN but allows for nurses having, or developing, more expert competency in some areas. The RCGP GPN competency suggests that it will take up to eighteen months to obtain competency in all areas of the GPN role.14
The role of the practice nurse is continually evolving and training provision needs to recognise this. Training needs to be flexible to meet the varied needs of the nurses coming into general practice nursing. It also needs to acknowledge the needs of the individual nurse, their previous experience and the requirements of the job role. There are ‘Fundamentals of Practice Nursing’ courses at many universities and also local courses to facilitate the transition to general practice nursing. The District Nursing and General Practice Education and Career Framework16 acknowledges the possible career progression in general practice nursing and provides a useful framework for benchmarking GPN roles and responsibilities to the required qualifications levels.
CONCLUSION
Despite the workforce pressures, it is an exciting time for nursing in general practice with expanding roles and increased career opportunities. Making the transition into general practice nursing can seem daunting but this can be alleviated with the right preparation and support.
*The RCGP General Practice Foundation Competencies for General Practice Nursing is the foundation for the Practice Nurse Curriculum, our online CPD resource.
REFERENCES
1. Health Education England. Our Strategic Intent. 2013
2. NHS England. Five Year Forward View. 2014
3. Lintern S. Concerns raised about ageing practice nurse workforce. Nursing Times. 21 November 2012 https://www.nursingtimes.net/concerns-raised-about-ageing-practice-nurse-workforce/5052029.article
4. The Queen’s Nursing Institute. General Practice Nursing in the 21st Century: A Time of Opportunity. 2015
5. NHS England. General Practice Forward View. April 2016
6. Essex Primary Care Inter-Professional Centre for Workforce Development (EPIC) http://www.epic-wd.org.uk/
7. The Primary Care Development Centre http://www.pcdc.org.uk/
8. Health and Social Care Information Centre. General and Personal Medical Services: Provisional Experimental statistics 2005-2015. April 2016
9. Lane P, Peake C. A scheme to increase practice nurse numbers. Nursing Times 2015;111:13: 22-25
10. The Queen’s Nursing Institute. Transition to General Practice Nursing. http://www.qni.org.uk/transition/transition_to_general_practice_nursing
11. Royal College of Nursing. Nurses employed by GPs: RCN guidance on good employment practice. 2014
12. Royal College of General Practitioners General Practice Foundation. Updated GPN nursing standards, 2015
13. Department of Health. Preceptorship Framework for Newly Registered Nurses, Midwives and Allied Health Professionals, 2010
14. Royal College of General Practitioners General Practice Foundation/ Royal College of Nursing. General Practice Nurse Competencies. December 2012 (updated May 2015).
15. Derby and Derbyshire Local Medical Committee and Health Education East Midlands. The Practice Nurse Project Competency Framework and Competency Development Plan, 2014
16. Health Education England. The District Nursing and General Practice Education and Career Framework. October 2015
