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A day in the life of ... a practice nurse partner

Linda Aldous

On working days Linda Aldous (pictured below, right, with her colleague Yvonne Coughlan) gets up at 4.30am so that she has plenty of time to travel from her home in Norfolk to the Tower Hamlets health centre in London where she works a practice nurse. The journey takes two-and-a-half hours, but she says it is worth it because her job and her practice are unique and irreplaceable.

Linda is a practice partner at the Bromley-by-Bow Health Centre, which is no ordinary GP practice. The practice has a holistic and "can-do" attitude to making a difference to people's health and it works in partnership with the Bromley By Bow Healthy Living Centre, a pioneering voluntary organisation that is working to regenerate the local area.

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The centre offers more than 100 activities each week, ranging from landscape design and furniture-making to complementary therapies, beauty treatments and art workshops.  Many of the activities are linked with the healthcare provided by the practice. There is exercise on prescription, an artist paints babies' portraits in the child health clinic, and women with leg ulcers go to flower- arranging classes! (The classes successfully get the women mobile.)

Health messages are delivered in creative and original ways. Asthmatic youngsters recently participated in an art project that helped them to learn more about managing their condition, and diabetic patients have participated in a diabetic fair, a hugely popular social event with creative and cookery activities, a tombola and goody bags of fruit and vegetables to take away.

The Healthy Living Centre is a stunning modern building filled with light. It has been designed as an open-plan public space where health centre clients, staff and people visiting the community centre mingle and communicate. By NHS standards it is a palace. The reception is an art gallery, and outside there is a pretty walled garden area with a pond and fountain. It has a welcoming and cheerful atmosphere.

Linda starts work at 8am and spends an hour tackling paperwork before she starts her surgery of three-and-a-half hours of booked appointments. She is an H-grade practice nurse working at specialist level. Her appointments cover everything, including new-patient checks, chronic disease management, women's health screening and travel health.

The practice currently has nine GPs, four nurses and a nurse practitioner, working across two sites - the other surgery is up the road in Stepney Green. But, despite the large team, there is a heavy and increasing workload and the patients have challenging needs. The practice's 10,200 patients are drawn from a very deprived population with a high ethnic mix and higher than average levels of chronic disease, particularly diabetes. At least 45 different languages are spoken in Tower Hamlets, and the consultation rate is high.

At lunchtime Linda will eat in the community centre café, where the practice pays for staff to have a subsidised meal. This encourages everyone to mix and socialise. This perk, along with awaydays to places like Paris, Brussels and Jersey, is part of the practice's ethos of investing in its staff.

It was the practice's philosophy of inclusiveness and equality that prompted the five GPs who were partners to invite Linda and the practice manager Pat Emin to join the partnership four years ago. Linda is a full profit-sharing partner. She attends all the partners' meetings, has equal voting rights and shoulders an equal share of the risks.

"I had been working at the practice since the early 1990s and had always been part of the decision-making. The practice offered me a partnership, partly to show I was valued and also to protect my status - the concern was that, as the practice grew, new people coming to work at the practice might not understand my relationship with the GPs."

Linda believes she was one of the first primary care nurses to become a practice partner. She knows of a handful of others, with whom she has formed a support group, and she hopes their numbers will grow as other nurses grasp the opportunities that are opening up with the new Personal Medical Services and GMS contracts.

As Linda says: "It can be a shock when you realise the risks you are taking on. As a partner you take on the responsibilities of being an employer, and you have to understand issues like health and safety. There is no training - you have to pick it up as you go along.

"We have a large multidisciplinary team - currently in excess of 26. We have salaried GPs, retainers and people we are responsible for as a training practice. Then there is the business side. I was involved with all the decisions about converting to PMS and contracting with the PCT.

"There are also all the clinical things to worry about - but at least I don't have any concerns that voice of nurses is not heard in our practice."

Each partner takes on different areas of responsibility. Linda currently is looking at cervical cytology targets and compiles reports for PMS monitoring, and recently she conducted a review of the practice's nursing workforce. The only niggle she has about being a nurse partner is that her profit share, unlike that of the GPs, is not pensionable. The issue is currently being looked at by the Department of Health.

After lunch on Tuesdays, Linda has a meeting with the nursing team, followed at 2.30pm by a practice meeting. It is her job to coordinate the sessions. At 4pm she starts a two-hour afternoon surgery.
 
After sorting out the administration arising from the afternoon surgery, Linda will leave the practice at 8pm for the long journey home and will probably collapse into bed at 11pm.

Linda, who has three young children, only recently moved to Norfolk. It was a lifestyle decision to move out of London in order to live in a bigger house, near good schools and to bring up her family away from the city. But she just could not leave the practice she has worked in for 14 years. She decided after a long discussion with the partners to cut down from fulltime working to two long days in the practice and to spend one day at home on administration.

"When I am in the practice I make sure I have as much patient contact time as possible. I am terribly fond of the patients, and I feel privileged to work here. This a very enabling place and it is very much part of the community.

"The practice is nonhierarchical, everyone is valued, and the philosophy is to facilitate patients to discover what they can do both for themselves and the community."