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My day: Working as director of the UK’s only nurse-led practice

My day: Working as director of the UK’s only nurse-led practice
Julie Belton

Julie Belton, strategic and operational director of Cuckoo Lane Surgery in west London talks Nursing in Practice through what it takes to run the UK’s only nurse-led practice.


I wake up and get ready to leave the house by around 7:00 am.


I get into work, and I hold the morning team briefing. This is just a quick five-minute huddle with all the team members on shift that day. That oversees any strategic, operational, or clinical issues that may be relevant that day. For example, to identify any patients that might be vulnerable, at end of life, or who just might need TLC in any way. Those notes the get written up, briefed, and sent to all team members.


After the meeting I head to my desk, check my pigeonhole, bring up my clinical system, and see what meetings I have planned for that day.

Then I get onto triaging the e-consults that come through to the practice. We have various ways that patients can make an appointment, but we’re doing a lot more electronic and telephone triage since Covid. There can be up to 20-25 e-consults coming through in a day, with patients presenting various symptoms.

I triage what needs an appointment and the things I am able to deal with myself. This might include medical certificates, where I bring the patient in and assess them for a medical assistance certificate. Or I might book them into an appointment if they need to be face-to-face with a colleague, whether that’s a physiotherapist, advanced nurse or one of the GPs we regularly work with.


My morning is usually punctuated by meetings which vary from week to week. Since I’m a director on Ealing GP Federation, this week I had a welcome meeting with a nurse researcher joining the federation. We met with her and her manager over Teams to discuss a work plan to get her started.

After that, we had a nurse practitioner meeting where all our advanced nurse practitioners (ANPs) meet and look at the systems we deliver to make any changes that are required.

When that finished, I jumped onto a call for the primary care network (PCN), as I am also a director of the Ealing Network PCN That was looking at System One training for the Pinnacle system, so I was fielding questions and working with the IT lead for the primary care network.

Then it’s back to picking up more triage as e-consults as they come in over the afternoon.


I’ll grab some lunch at my desk whenever I can; I often have to fit that in around our afternoon briefing.


Then we have our second huddle of the day, where we do the same thing as in the morning and come up with any strategic of clinical issues for the team to write up and send out.

In between looking at some more triage, people might be asking me to sign patient directives. For instance, a patient might be having a B12 injection, and a healthcare assistant needs to have that signed off, or I might be asked for an opinion by one of our nurses.

Then I’m looking at test results for anything that might come in for anything urgent. Generally, each clinician deals with their own results, but I might give all the results a look over to check that it’s been appropriately treated. I usually look over all the results coming in to check for any gross abnormalities.


On this particular day, I had a telephone call with an ANP working with the elderly in Utrecht in Holland who wanted me to go through a presentation of what she could learn from our practice.

Then, in my clinical director role, I have been moving all the practices in our PCN onto a new website, so I’m liaising with the company we’ve been working with. Throughout the whole day I’m responding to emails on everything from accountancy to medical student placements and phlebotomy training.


­At this time the practice closes, so it’s just about tying up the loose ends of governance and making sure that everything that needs to be done has been done.


Now it’s time to finish up for the day and head home. I live near the river in Richmond, so I’ll try to gather myself for a walk outside in the last of the day.


Profile: Julie Belton

Location Ealing, west London

Roles Strategic and operational director at Cuckoo Lane Surgery; director at The Ealing Network PCN and director at Ealing GP Federation

Areas of responsibility Is responsible for the operational oversight and day to day running of the practice. This involves managing the team of nurses who are responsible for the majority of clinical care.


Read more articles from the My Day series here


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