This site is intended for health professionals only

Fragmentation and funding loss thwarts training

A new survey reveals more than half of practice nurses need more training to do their jobs. But PCT reorganisations and 2004 Contract finances have put paid to funding. Could new providers save the day?

Marilyn Eveleigh
Consultant Editor

The shortage of NHS training funds for nursing is a reality. Media headlines and campaigns highlight the lack of continual professional development (CPD) across the country - be it the raid of budgets to pay for trust overspend, the paucity of mandatory training or staff shortages blocking release for training.

Now a survey of practice nurses (PNs) by WIPP, the Working in Partnership Programme, has formally revealed that over 50% require further training to do their current jobs. Historically and anecdotally some PNs have had fantastic support for training and development from GP employers - yet others have scant. I'm not surprised by the findings.  Why do we have such patchy training provision?

First, GP partnerships are contracted by the NHS as independent providers - they are small businesses that employ their own staff to deliver a national contract as they see fit. Yet nationally, patients, GP partners and PNs themselves have no common agreement and perception of the practice nursing role - it is an evolution of the individual practice philosophy and needs. The title covers those nurses who undertake basic treatment room tasks as well as those providing detailed care packages in chronic disease management and triage. Wide variation in patient profiles and practice size, from single-handed GPs to large partnerships with branch surgeries and enhanced services further influence the role - and the perception of the training required to fulfil it.
Second, before the 2004 GMS Contract, general practice staff had 70% of salaries reimbursed by the PCT and GMS budgets were top-sliced to provide central training funds/programmes. Now practices fund the full cost of training and staff from their share of those budgets that were distributed to them under the new Contract.
This central funding loss, with freedom for 10,600 individual practices to choose how to spend it, has led to greater inequalities in practice nurse training, variable clinical standards and lack of employer accountability. This goes alongside a reduction in hours/posts for many PCT practice nurse leads/trainers/facilitators and the loss of local practical training.

In addition, PCT reorganisations further fragmented dedicated PN leadership posts - and with it, their insight and responsibility to ensure PN core competencies and standards. Training has become more haphazard, training organisations report a reduction in PCT courses and a rise in PNs financing themselves - and pharmaceutical companies have filled the gaps.
Such new NHS contract changes and visions raise an important question: should PCT commissioners of independent contractors for healthcare services be funding provider staff training? Independent businesses, private companies and social enterprise units are increasingly likely to be the healthcare providers of the future, following the Department of Health direction to improve patient choice and open market forces. PCT commissioners are contracting for good quality outcomes for patients and are not going to set contracts with detailed training and skill mix elements.
So who will? WIPP is to develop standards for the role and training of general practice nurses, building on the success of the General Practice Nurse Toolkit. They are seeking endorsement by the RCN, the Royal College of General Practitioners and the BMA to influence employers and establish equality in the standard of patient services. If successful, I predict that monitoring by PCTs could follow. Watch this space!

Despite this dissatisfaction with training, PN posts have risen by 44% over the last decade to 14,554 whole time equivalents, with 90% working part-time, few vacancies and a lower turnover compared with other nursing disciplines. These nurses have the opportunity to negotiate appropriate employment
conditions, remuneration and training packages. That is the bonus of independent and private providers of healthcare.
Could these three points support PN training in your locality?

  1. The QOF requires nurses to have a professional development plan.  This does not always require attendance on a training course - inhouse/cascade training, shadowing, e-learning, reading and one-to-one training are perfectly appropriate. The revised NMC standards require nurses to participate in appropriate learning and practice activities that develop competencies and performance. Be imaginative.
  2. Practices can claim tax relief for staff training fees.
  3. Specialist nurses in acute settings should be more able/willing to deliver training to primary care. Practice-based commissioners must ensure appropriate safe skills in primary care nurses are established when shifting services. Can you influence this?

How is training in your PCT? Let NiP know so we can publish some good news! Could you enter the NiP Awards because a training event established your skills? Closing date is 23 May 2008.