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Interview: Sara Richards Chair of the RCN Practice Nurse Association

What is your professional background?
I have worked in general practice for most of my working life. I started as the first practice nurse in the practice around 18 years ago and developed the PN job until we had three nurses and were running several clinics, including asthma, menopause, diabetic, immunisations, travel and cryocautery. So I know what it is like to work on my own, how isolating it is, and I know about teamwork as we worked closely with the district nurses and health visitors.
I am now also a cervical cytology course facilitator and trainer/ lecturer and am nearing the end of a nursing degree course.

Can you tell us about the RCN Practice Nurse Association (PNA)?
The RCN PNA is one of the member forums in the RCN. We have seven members on the Steering Committee who are all (except one) elected volunteers who give their time free to support our members. We have representation from all four countries, our Scottish representative being a guest member. Our aims are to represent and promote the interests of nurses working in general practice, disseminate information to and from the RCN to members, and develop opportunities for collaborative working inside and outside the RCN.
At the moment we are involved with lobbying for PNs to be given their full annual pay increase, cost of living allowance, and a better deal on pensions. We have been working on defining the role of the PN and PN competencies with a view to the RCN publishing an up-to-date document to assist primary care trusts (PCTs) and GPs when employing PNs. We acknowledge the work done on these subjects by many nurses and have used much of this work to prepare our document.
The Committee is involved in many other issues and with other Committees such as the National Association of Primary Care, the National Association of Primary Care Educators, the Prostate Cancer Risk Management Scientific Reference Group, the National Collaborating Centre for Primary Care (Diabetes NSF), Practice Nurse Journal, the Royal College of General Practitioners (RCGP) Quality Practice Awards, the RCGP Adolescent Task Group, and Heart Failure Guidelines with the National Collaborating Centre for Chronic Diseases, to name but a few!
So you can see we are involved in many areas that affect PNs. It is important to get the PN viewpoint across while National Service Frameworks (NSFs) and other guidelines are being developed, because no one really understands the role of the PN. This is because many PNs work on their own and in one-to-one consultations with patients. More and more work is being filtered down to them, and the PNA see it as their role to make people aware of the problems that PNs face in trying to fit the work into their already busy working lives.
Our power lies in having 8,000 members and in the amount of networking that we do. We may not be able to solve all the problems, but we know a person who can!

The NHS is undergoing much reorganisation. Do you think the changes taking place in primary care are for the better?
I think the changes are very necessary and will be for the good of the patient and the staff in the long run. However, the changes are causing feelings of unrest and instability among staff everywhere, and I think it will probably get worse before it gets better. I would like to see primary care based around the practice team, with patients able to see the most appropriate person to deal with their problem. I would also like to see doctors and nurses working in partnership together with other professions allied to medicine (PAMs), and everyone valued for the work they do - no more "them and us" situations.

How would you organise primary care if you were in charge?
I would keep services local to patients with consultants coming out to practices or groups of practices. This would cut down on many car journeys and all the aggro of travelling on our inadequate public transport system.
I would run a campaign to educate patients about the most appropriate use of the existing services, such as accident and emergency, walk-in centres, pharmacies and minor injuries units, and give nurses the power of referral to X-ray, physiotherapy and other agencies as needed and appropriate for the patients.

With the new PCTs, many PNs may be unsure about their employment status, and where to go for educational resources and professional support. What advice can you offer them?
Many PCTs are now employing professional development nurses who will be there to provide support and educational advice. The PNA recently held a workshop for these nurses responding to letters and emails we had had from them asking for help and advice. A total of 164 of them are now on our database and, following the success of the workshop, they are hoping to have another next year to continue their networking. The PNA have set up a chatroom for them on our website:  
The RCN also has primary care advisers now in each region of England and in the other three countries. The PNA answers many letters and emails giving support and advice, and many nurses contact Lynn Young, our primary care adviser, at the RCN headquarters.

What are your views on the new GP Contract?
The draft contract looks very positive for PNs, but until the doctors have agreed it there is nothing we can do. The RCN have commented on it.

Practice nurses are often being told that they should let their voice be heard. But on a practical level, how can they do this? Who should they be speaking to?
The PNA tries to be a voice for PNs, and we are always urging them to get in touch with us through our website (see above) or newsletter. However, PNs should also lobby for themselves by writing to their MPs and Alan Milburn at the Department of Health, and by contacting their PCT clinical governance leads. As I said before, there is power in numbers.

Primary care nurses are expanding their role with nurse prescribing. But many are finding it difficult to find the time for this new training. Do you have any advice for these nurses?
There does seem to be a problem for PNs in finding the time to go on the course as there has been no money allocated for locum cover or for GPs who are being asked to do the mentoring. Our advice at the moment is for PNs to persuade GPs that nurse prescribing will save money and time in the end and will be beneficial to patients so that the GPs will give them time off. The RCN and the PNA will keep up the pressure for extra money to be made available for locums and mentoring.

What are your views on the recent consultative document on supplementary prescribing from the MCA?
The supplementary prescribing document makes heavy weather of the subject and would involve nurses and doctors in a lot more work devising management plans. I hope the MCA will review it in the light of all the comments made.

What do you think the future holds for practice nursing?
A more structured career pathway, huge opportunities for innovation and collaborative working, an even more satisfying work environment, and greater opportunities for professional development.

And finally … have you any message you would like to give to practice nurses?
Please value yourselves - most of you do not think you are doing anything out of the ordinary, but I can assure you that you are. There is some wonderful innovative work going on. Let us all know what you are doing, through our newsletter, nursing journals, and by putting yourselves forward for the many awards that are around.
We may feel in the slough of despond at the moment, but I'm sure there are better times coming. In the meantime, talk to each other, support each other and take every opportunity to meet, learn and lobby!

NiP would like to thank Sara for taking the time to answer our questions.