Award-winning general practice nurse Maggi Bradley is spotlighting the value student nurses can bring to primary care following the successful overhaul of her practice’s annual health reviews for people with learning disabilities – a model she hopes could be replicated across other PCNs and specialisms.
Having spent time working with a student learning disabilities nurse, Maggi Bradley – a practice nurse at Aughton Surgery in West Lancashire and nursing clinical lead at Sefton Training Hub – identified that the annual health checks her practice was running for people with learning disabilities could be improved.
‘Sometimes it’s just a matter of thinking how we can do things differently,’ she explains. ‘We were very much coming at it from an adult nurse perspective, and we weren’t really understanding the needs of the person with LD.’
Engaging with the local university, she invited the student nurse back alongside an additional third-year candidate to come and do a three-month placement at Aughton Surgery. Together, with Ms Bradley as a mentor, they were given ownership of assessing the entire annual health check process, from communications being sent to patients to contact with reception staff and their appointment in-person, looking at it from the patient perspective with the benefit of their specialist knowledge.
Reasonable adjustments and preparation
The student learning disabilities nurses offered insight into adapted communication like easy-read letters and action plans, best practice training for teams and awareness of reasonable adjustments, such as longer appointment times, using pictures or large print when providing information, and offering appointments at the beginning or end of the day when the practice is less busy.
Additional adjustments included streamlined coding so all patients with learning disabilities were identified, and ensuring their records included information on their reasonable adjustments, likes and dislikes for use by all practitioners.
‘The key is the work that goes on before you see them,’ says Ms Bradley, ‘You’re not setting the right environment that’s conducive to an interaction if you haven’t done the work before.’
She adds: ‘I wouldn’t have been aware of not wearing a particular colour or certain smells that might upset people. I never gave these things a thought. We were able to make quite big differences to the way we operated.’
The group was able to offer 24 reviews during the three-month period and feedback from both patients and colleagues was extremely positive, with testimonials highlighting how patients felt valued, listened to and comfortable, while staff were full of praise for the improvements the students had made and the impact their placement had had on the practice and the annual review process.
A two-way street of learning
Of course, it was a two-way street, and the students themselves were able to develop their skills, understanding and confidence. There were challenges in that the required proficiencies the students needed to attain were geared towards secondary care, but with some creativity can be adapted for primary care.
Ms Bradley says, ‘A lot of it is around changing people’s way of thinking, because for a long time we’ve not had student nurses. The proficiencies were geared towards secondary care, but we just had to think outside the box to match them into primary care. Hopefully that’s changing, and students will increasingly be able to see a fit for themselves in primary care.’
She also stresses the importance of ensuring student nurses feel involved and included, both for them to get the most out of their placement and practices to get the best out of the students. She says a whole practice approach is needed where students feel like part of the team to ensure the best outcome for all parties.
‘Initially you might have to set a few things up, but these students will take work off you and they’re going to leave you with a load of resources to help you do things quicker and better in the future,’ she says.
Although she feels the model would probably work well with first- or second-year students working alongside third-years, the independence and leadership involved in such a project has been ideal for third-year candidates and can be applied to other specialisms depending on the local need. Ms Bradley has already done some work with a student mental health nurse and intends on replicating the model with a mental health focus, for instance.
The future for the project
The success of the project has already been replicated at another practice within the primary care network (PCN), and in December four further student learning disability nurses will be taking up rotating placements across the PCN.
Meanwhile, the model is going to be rolled out across practices in Chester with a focus on student paediatric nurses. The first student nurse who worked with Bradley and inspired the project is also now employed as a learning disabilities nurse across the PCN, working with practices as well as performing annual reviews on patients with a learning disability who live in a care home.
‘It’s really exciting to see the improvements that having a designated nurse who understands that speciality can make,’ says Ms Bradley.
‘And then if we’re able to demonstrate that we can use this model for mental health student nurses – severe mental illness is another annual review that needs to take place within general practice – there’s no reason why those student nurses can’t lead on that in future. We’re hoping that it’s going to make a difference.’
Ms Bradley, a Queen’s Nurse with 25 years’ experience of nursing in general practice, won the Nursing Award at the 2021 General Practice Awards in 2021, run by Nursing in Practice publisher Cogora to recognise the UK’s primary care professionals.
She was nominated for setting up group video clinics after noticing patients with long-term conditions were feeling isolation, fear and anxiety during the Covid-19 pandemic.
She says the group video clinics are continuing and that, without the success of which, she ‘wouldn’t have had the confidence to stick my neck out and go for it’ and pursue this latest project.
‘As well as clinicians benefitting, hopefully the people that will benefit the most will be the patients, because they will now have somebody dedicated to them, who understands them and will educate the rest of us on how to do a better job,’ she says.
Maggi Bradley, and third year learning disability student nurses from Edge Hill University – Jessica Lea, Kimberley Wareing and Shirley Fabian – who worked together on the project