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The general practice nursing plan - too little, too late?

Practice nursing could be the key to putting the NHS back on its feet, but first it needs to boost numbers. Alice Harrold examines whether the Government’s plan has come in time

Practice nursing is finally getting the attention it deserves and desperately needs in a new plan to support the workforce, but will the Government be able to halt the profession’s mass exodus?

In response to previously published plans and research, NHS England, led by the chief nursing officer (CNO) Professor Jane Cummings, has released General Practice – Developing Confidence, Capability And Capacity: A 10-Point Action Plan For General Practice Nursing. Through this it aims to raise the profile of practice nursing as a ‘first-destination career’ by improving access to training and progression, increasing the number of pre-registration nurse placements, enhancing retention and supporting return-to-work schemes for practice nurses. 

 Professor Jane Cummings: 'If  you are thinking of retiring,  please reconsider'

The action plan also sets out the work needed to deliver more convenient access to care, more personalised care in the community and a stronger focus on prevention for the growing and ageing population.

The plan, which is backed by a £15m investment, aims to help direct resources to the areas where improvements are needed most. Four regional delivery boards will be established to support its implementation.

Professor Helen Stokes-Lampard, chair of the Royal College of General Practitioners (RCGP), said the college has been calling for elements of this plan to be implemented for ‘many years’ now.

‘Practice nurses are incredibly important members of the practice team, and highly valued by GPs and patients alike – but as patient demand has soared, numbers of practice nurses, like GPs, have not kept pace,’ Professor Stokes-Lampard said.

‘The College has been calling for elements of this plan to be introduced for many years, so we’re really pleased to see wheels being put into motion. We now need all aspects of this plan to be implemented in full and as swiftly as possible – and we will play our part in ensuring it is a success.’

But is it enough to reverse a trend that has existed in general practice nursing for years? The practice nursing workforce is aging, with an ever increasing proportion approaching retirement and few coming into the profession to replace them.

A poll by the Queen’s Nursing Institute (QNI) last year found that two-thirds of practice nurses believed they were underpaid and one in three planned to leave the profession by 2020. With this forecast less than three years away, it is not just a recruitment solution that’s required, but a focus on retention too.

Nurses in general practice are also going into early retirement, the QNI research found, citing poor remuneration and having to work other jobs.

You can’t ignore the impact of the pay cap, either. Kathryn Yates, professional lead for primary and community care at the Royal College of Nursing (RCN), believes this is the first barrier to solving the workforce problems. 

She said: ‘The general practice nursing workforce has not escaped the effects of the pay cap. Many nursing staff are struggling to afford the cost of living and are leaving the nursing profession.
If we are to tackle staff shortages across all sectors the pay cap must be scrapped.’

A nurse practitioner who asked to remain anonymous told Nursing In Practice: ‘General practices could help with retention and encourage the expansion of practice nursing if they paid Agenda for Change rates. If you are a young nurse who may need maternity leave, then a lot of general practices only pay statutory rates.’

The NHS Alliance has called for a standardised agreement on pay, terms and conditions for practice nurses because their terms and conditions continue to vary today as they did 20 years ago.

‘The requirement to have a clearly set out job description, competency framework and a contract of employment is still variable,’ NHS Alliance chair and Queen’s nurse Heather Henry said.

But she added that there would need to be an incentive for practices to implement the necessary changes if they were going to happen.

As part of the work leading up to the 10-point plan last year, NHS England commissioned Ipsos Mori to form a series of focus groups to identify the issues related to recruitment, retention and return for practice nurses.

The research provided evidence direct from practice nurses about their roles and the challenges they face. The findings led to proposals to help:

  • Increase the number of pre-registration nurse placements.
  • Improve retention of the existing nursing workforce.
  • Support return-to-work schemes for practice nurses.
  • Improve the training capacity in general practice.

The action plan promises more primary care placements for trainees, which means that the existing practice nurse workforce will need to take on more mentorship roles.

But as good as the idea sounds in theory, putting it into practice effectively may be hard to achieve. Practice nurse Julie Anne Baird-Paul told Nursing In Practice: ‘As a nurse working in GP land, I’d be more than happy to be part of training new nurses. But who is going to do my job, which is non stop, with never enough hours in the day, and leaves me stretched beyond capacity? I’m not sure how that would work in real life.’

GPs were given a similar plan in the General Practice Forward View, published in April 2016, which promised them greater support and a boost to their workforce numbers. 

Practice nurses were also included in the Forward View, which made it clear that to meet rising demand for the NHS, practice nurses will be expected to play an increasing role in providing primary care. This included investment to fund a support and development programme for nursing teams in primary care over the next four years. The 10-point plan sets out the practical ways in which those goals can be met.

Health Education England (HEE) published the General Practice Nursing (GPN) Workforce Development Plan – Recognise, Rethink and Reform in March this year. This included a series of recommendations for organisations. It builds on the findings from the Ipsos Mori research, including the QNI’s survey: General Practice Nursing In The 21 Century – A Time Of Opportunity. HEE’s recommendations were a key consideration in the development of the practice nursing 10-point action plan. The research and the 10-point action plan also align with Leading Change, Adding Value (LCAV); A Framework for Nursing, Midwifery and Care Staff, published in May 2016, by helping practice nurses to focus on where change can be made and how to do this.

According to NHS England, all 10 actions of the new plan should be considered part of an overall formula to develop general practice nursing. They complement each other and should be seen in the overall context of the General Practice Forward View.

The plan sets out the measures, which will be taken forward by NHS England, HEE, NHS Improvement, Public Health England, the RCN, the RCGP, the QNI and the British Medical Association. These organisations will support commissioners and providers to implement the actions on a local level.

The plan specifies key milestones, which will allow progress to be measured across practice nursing for the first time.

The actions include measures to:

  • Increase uptake and promote nursing in general practice – by raising the profile of practice nursing through the Image of Nursing programme, offering clinical placements for undergraduates and supporting additional routes into general practice nursing.
  • Support for existing practice nurses – all nurses who are new to general practice will have access to an induction programme, training and mentoring and expanded leadership and career opportunities.
  • Encourage former practice nurses to return to work – the national return to practice programme will now include practice nurses. Regional practice nursing boards will provide a platform to share how best to do this.

Commenting on these measures, Professor Cummings said: ‘Nurses working in general practice may not have always received the recognition they deserved in the past, but they are central to our plan to improve care for patients and ensure the NHS is fit for the future.

‘That is why I am determined to ensure there is a proper career development programme for those who choose this vital path and to make it an attractive first choice for newly qualified nurses as well as helping experienced staff take advantage of the flexibility it offers to re-enter the workforce.’

Dr Arvind Madan, a GP in east London and NHS England director of primary care, said that practice nursing teams are a ‘vital component’ of the general practice workforce, and that this support plan will ‘go a significant way to supporting general practice, helping deliver the care that matters most to patients. We look forward to welcoming, and welcoming back, as many practice nurses to the profession as possible.’

But it is clear that practice nurses need more than words to cope with the mounting pressures on primary care. The summer of action has shown that this workforce cannot and will not wait any longer to be recognised and supported in their roles. If implemented properly, this plan could be the game charger they need.