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A day in the life of ... a primary care practitioner

The role of primary care practitioner was created by North Hampshire PCT following the decision to employ a nurse to work in partnership with an employed GP and practice manager to develop services within this recently taken on PCT practice. The role also focuses on the rest of the community's public health needs and addresses the health inequality issues specific to the area. It must be noted that the PCT does not see any other area within its trust as less important, but this particular locality has historically had the greatest level of need.

The opportunity to develop and encourage a more modern way of working within primary care was also attributed to my role. This involves me working as an educator, encouraging changes in work structures across professional boundaries to develop effective and efficient working relationships, and utilising specialist knowledge and skills most appropriately to ensure equal access of service to every patient regardless of where it's delivered.

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I became a registered nurse in 1994, having completed a diploma in nursing. I knew while completing my training that I wanted to steer my career towards primary care, so following 2 years of consolidating my basic training in secondary care I moved into primary care as a community staff nurse, where I gained sponsorship to undertake a BA Honours degree as a specialist practitioner in community nursing. After successfully completing my degree I became a district nurse working in an affluent practice in Surrey, where I remained until I moved into this new position.

When I started this job it seemed very daunting; it was like having a blank piece of paper and not knowing where to start writing. A job description had been developed and so I used that to start mapping out how I would develop the role. At first I thought the only way of meeting the main objectives would be to divide the role in two, addressing practice-based issues first and then the wider community issues. However, as the practice is based within the locality, I found that developing services often overlapped. I now try to incorporate any developments into both areas. For example, the practice nurse in my team is family planning trained and enjoys this aspect of her job. So on developing contraception and sexual health services within the area, we decided to set up a service within the practice that was accessible to anyone in the locality regardless of which practice they belonged to.

As a primary care practitioner my week starts at 9am Monday morning and finishes 5pm Friday. I have divided my week into two. Mondays and Tuesday are fixed clinical days, giving flexibility for the rest of the week to work on the assessing, identifying, evaluating, changing and developing aspect of my role.

I see my priority as being team leader for the nursing team within the practice, whether that means developing the nursing services or changing and improving practice developments in general, such as writing and developing guidelines and policies that are quality assured, promote clinical excellence and improve patient care. I work closely with the practice and community nurses to encourage a multifaceted and integrated nursing approach as part of the new modernisation concept of nursing in primary care.(1) This has encouraged the nurses to work across professional boundaries to deliver and share their specialist skills, especially when striving to deliver NSF and local development plans.

In order to achieve the above I have had to take an active role in participating in clinical governance agendas for primary care nursing, to ensure appropriate, safe and evidence-based practice is being set up and delivered. I also ensure that I keep up-to-date with clinical issues and nursing skills by taking part in running clinics within the practice, some generic and others more specific to chronic disease management, especially diabetes.

Diabetes is a professional interest of mine. I have become the PCT "initiating of insulin in primary care" trainer. This has been designed recently to enable primary care practitioners, both nurses and doctors, who have appropriate training and an interest in diabetes, to initiate insulin to patients with type 2 diabetes who would previously have needed to be referred to secondary care. This highlighted to me the need to network with secondary care so that other services could be moved into primary care, improving patients' access to services.

The other aspect of my role focuses on the health needs of the local community regardless of which GP practice they belong to. In order to initiate, contribute, prevent chronic disease and promote improved health, I have had to gain an understanding of the public health profile, join local implementation groups and forums (of which many are set up by other organisations such as the local council) to identify ways of addressing different health issues and/or social factors affecting health. From this I have been able to identify project areas and started to develop and initiate services, such as developing child and adolescent services within the locality that will tackle the issue of increasing teenage pregnancy. With a multiagency approach I feel certain provisions are developing that have begun to address this issue, and again I have been able to link this back into the PMS practice.

Being a health representative for other organisations is a very enjoyable extension of my nursing role, as it allows me an insight into how other services are addressing similar (if not the same) issues. I have found that joint working sometimes enables better delivery of services and better outcomes.

Another development that I am extremely proud of is a nurse-led service that I coordinate and have set up with other PCT nurses, which provides healthcare and services in an area that has historically suffered from a lack of access to health services despite having some of the greatest health needs within Basingstoke. The project is called "Health Start" and is located in a newly built community centre. The aim of this service is to:

  • Deliver care in a different way that is based upon the expressed needs of the local population.
  • Allow current staff to develop new ways of working that look at broader health issues.
  • Use the experience of existing staff working across the PCT.
  • Engage voluntary and other agencies to broaden and strengthen the services delivered from "Health Start".
  • Improve accessibility and appropriateness of location, which in some cases is all that is necessary.

The provision of these services is determined by our local delivery plan, but more importantly from listening to what the community believes it needs. Unfortunately I am unable to comment on how it is progressing as it is still in the early stages but it is envisaged that it will be of huge benefit to the community and will reduce some of the health inequalities that have been recognised.

As I said earlier, my role is new to everyone within the PCT so it has been very difficult to know where to start. Hence my approach is based on using the new framework for nursing in primary care that was identified in Liberating the talents.(1) However, I have realised that this role will constantly evolve to meet the needs of the community and to keep up-to-date with the ever-changing health service.

Some are still not able to grasp the concept of my role. They think it is an expansion of the practice nurse role, or another management role, or that I am a member of the nursing modernisation team or public health team. I, however, feel that my role is an amalgamation of all of these, striving to improve health in primary care with the opportunity to identify what is really required for the population and draw the most appropriate services from the bigger organisation.

I feel extremely privileged to be involved in this role and the influences it has within primary care. Although they cannot yet be measured, I hope the developments and changes that I have made, with the help of my supportive colleagues, reduce inequalities in the practice and the wider community. I think what is most important is that we share our skills and knowledge, as at the end of the day we are all striving to achieve the same goal - improving patient care.

Reference

  1. Department of Health. Liberating the talents. London: DoH; 2002.