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GPIAG: supporting nurses in primary care

Thea Oliver
RGN BSc(Hons)
Independent Nurse Prescriber

Nurse Practitioner
Armada Family Practice
Whitchurch Health Centre
Bristol

Member of GPIAG Practice Nurse Working Party
W: www.gpiag.org

Consider the scenario. A new practice nurse taking up her position is told: "You are running the asthma clinic, it happens on Wednesdays." That is what I faced 15 years ago. There was no-one to ask, so I "muddled through" with the help of pharmaceutical reps and guess work. I was fortunate to get funding from pharma companies to do the asthma and COPD diplomas subsequently, learning more about smoking and allergy. "But", I hear you say, "that wouldn't happen in 2007."
Unfortunately it does. So if it happens to you, whom do you ask for help?
This situation is the main driver behind the GPIAG Practice Nurse Working Party's (PNWP) project to support nurses in primary care to provide excellent respiratory care to our patients. In 1987 a group of six GPs formed the GPs in Asthma Group (GPIAG). From these small beginnings the group grew to become the largest primary care respiratory network and is now celebrating its 20th year, with nearly 2,000 members, 45% of whom are nurses.(1) The outlook for people with respiratory disease is much better than it was 20 years ago and care is provided to more consistent standards.
Despite this statistics show respiratory disease still remains a cause for great concern.(2) With primary care now recognised as a key player in the prevention and management of respiratory disease, the work of the GPIAG is more important than ever.
The GPIAG recognises the central role of primary care nurses in respiratory management and that supporting the needs of its nurse members, both current and future, is pivotal to the goal of achieving optimal respiratory health for all. Full membership of the charity is open to any healthcare professional working in primary care in the UK for a subsidised fee. There is a concessionary fee for healthcare professionals on lower income to make membership more accessible to practice nurses, especially those working part-time. Supporter membership is open to anyone else interested in primary care respiratory medicine.
The GPIAG has a vision of developing a UK-wide network of primary care nurses with a special
interest in respiratory care. As a result, in 2005 a group of 15 practice nurses from across the UK, with special
interest in respiratory care, was recruited to brainstorm the best way to support practice nurses caring for respiratory patients. This working party, sponsored by an educational grant from Altana Pharma (a Nycomed company) and led by Stephanie Wolfe, meets regularly in person and by email, to examine how best to support not only our nurse members but all nurses working in primary care.
A programme of developmental activities for nurses has been devised including:

  • Competence-based skill sets.
  • A series of regional meetings. 
  • A series of protocols and patient group directions (PGDs).
  • A web-based discussion forum.

Full details of these are available on the nurses' pages of the GPIAG website (www.gpiag.org).

A new respiratory skills toolkit for primary care nurses
The Practice Nurse Working Party (PNWP) established that many nurses working in primary care have been asked to provide management of respiratory diseases, but have not necessarily had access to adequate training.  In order to standardise education and support for these nurses Ruth McArthur, in conjunction with the working party, has developed a list of standardisation levels in line with the knowledge and skills framework (KSF).(3) The KSF was published in 2004 and is used to ensure that nurses meet the expected levels for career progression within the remit of Agenda for Change, as well as identifying the knowledge and skills that need to be applied to practice areas.     
The KSF is a very valuable document for all nurses who wish to progress. A framework on which to base their level of involvement is useful. Therefore the PNWP has developed the toolkit to be used by those with an interest in respiratory health wanting to enhance their specialist skills. Underpinning these levels is Roach's (1992) definition of competence: "The state of having the knowledge, judgement, skills, energy, experience and motivation required to respond adequately to the demands of one's professional responsibilities."(4)
It is accepted that not all nurses caring for respiratory patients as part of their workload will need or even want to work at an advanced level. However, all nurses need to be able to demonstrate continuous professional development and to indicate in their annual appraisal where gaps in their knowledge lie and what steps are required to update or maintain existing levels. This toolkit provides guidance as to the levels of expertise, training, tasks and responsibilities necessary to deliver quality respiratory care within a primary care setting.
The basic skills recommended are in line with KSF recommendations and will fulfil PREP requirements for the NMC reregistration (see Box 1).(5)

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Nurses working at all levels will need to keep their skills and knowledge updated and would benefit from joining a local respiratory interest group and/or the GPIAG.
The GPIAG is not a training provider but can sign-post interested individuals to recognised accredited training providers such as ARTP, Education for Health, Respiratory Education UK and other accredited regional providers.
Education for Health and Respiratory Education UK are developing the use of the KSF document to ensure that competencies for each of their modules are mapped against it, specifically looking at core competencies and skills in delivering respiratory care. The toolkit will fit neatly with this.
 
Regional networks across the UK
The PNWP has identified the importance of UK-wide local groups for nurses delivering respiratory care to enable them to keep up-to-date with clinical developments. We have been mapping current activity and have held a series of regional meetings across the UK aimed at establishing regional networks at which members will be able to share information, ideas and best practice. These meetings will be supported by varying pharma companies to avoid the accusation of bias towards one company and to keep costs down. It is also envisaged that a mentorship or "buddy" scheme will evolve where more experienced nurses will offer support, especially to those working in isolation.
If you are a member of an established group and would like to know more about the benefits of group affiliation to GPIAG please send your contact details to: info@gpiag.org
If you would like to find a group near you, or indeed are interested in setting up a group please contact info@gpiag.org The GPIAG have produced a resource pack to help nurses set up local networks.

GPIAG Protocols and PGDs
A series of protocols and PGDs have been developed specifically for primary care nurses to use in practice (subject to approval from PCT/practice). These will be available to download, free of charge, to members of GPIAG from the nurses pages on the GPIAG website.
The 2007 series of protocols include:

  • Protocol for asthma clinic, first visit, follow-up, and review.
  • Protocol for COPD review and follow-up.
  • Protocol for the use of spirometry in practice.
  • Protocol for managing exacerbations of COPD.
  • Protocol for managing acute asthma.

The 2007 series of PGDs include:

  • Reversibility testing with spirometry.
  • Bronchodilator reversibility testing, oral steroid trials.
  • Administration of high-dose bronchodilators/oral steroids for asthma and COPD.
  • The use of oxygen therapy.

GPIAG website for nurses
As part of the major upgrade of the website there is now a section specifically for nurse members. This section includes a range of materials and resources, and a discussion forum specifically for nurse members to discuss clinical and management issues. This discussion forum will also act as a networking tool, helping to put nurses in touch with each other to discuss common problems and ideas for best practice. It is envisaged that this will be especially useful for those nurses working in isolation, or who do not have easy access to group meetings. Please visit the website; it is helpful and user-friendly - www.gpiag.org

References

  1. Levy M, et al. The UK General Practice Airways Group (GPIAG): its formation, development, and influence on the management of asthma and other respiratory diseases over the last twenty years.  Primary Care Respir J 2007;16:132-9.
  2. Department of Health. A healthier future: a framework for respiratory conditions. Northern Ireland: DH Social Services and Public Safety; 2006.
  3. Department of Health. The NHS knowledge and skills framework (NHS KSF) and the development review process. London: DH; 2004.

The author would like to acknowledge the tremendous contribution of Mrs Stephanie Wolfe who chairs the PNWP and who is on the GPIAG Committee in raising the profile of nurses within the GPIAG , Ruth McArthur who put together the skill sets tool kit, Carol Stoneham who co-ordinates the regional network mapping, and Gail Ryan from the GPIAG secretariat as well as everyone involved in the group:
Alison Ashworth
Marilyn Eveleigh
Linda French
Gill Hall
Tish Johnson
Ruth McArthur
Thea Oliver
Marilyn Plummer
Diane Postle
Stephanie Reilly - Vice Chair
Carol Stonham - Group Secretary
June Roberts
Jenny Willington
Stephanie Wolfe - Chair
Maria Yates