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A warm welcome to HCAs joining general practice

Lynn Young
Primary Healthcare Adviser

The more mature among us are able to remember the days of the previous General Practice contract in 1990 and how it increased the practice nurse population from 8,000 to 18,000. The 1990 contract was the catalyst to building a vibrant practice nurse workforce and making it an integral and essential part of the primary care team. Practice nurses now make a huge contribution to individual, family and community health.
Now in 2005 a brand new GP contract is being implemented and is, it would seem, bedding down quite nicely, thanks to many people's hard work and endeavours. But the new GMS demands a new workforce and not necessarily more nurses and doctors. The topic of skillmix is yet again under the spotlight, and there is a growing consensus that a large chunk of GMS can be well provided by properly trained, supervised and competent healthcare assistants (HCAs). We also need to bear in mind that it is critical to patient care and the health of the team that the employment of HCAs is underpinned by the very best of training and education.
The standard package for HCAs is the NVQ programme, but it is becoming increasingly evident that this is not adequate for HCAs in general practice. It is quite clear that existing NVQ programmes are predominantly designed around the needs of hospital-based HCAs, and this must be strongly challenged at national level. A number of areas have deemed their local NVQ programme to be so inappropriate for general practice that alternative training schemes have been set up. The point is that we have to develop a workforce that is fit for the needs of general practice, and therefore new GMS, and not simply hospitals. Local higher education institutes must respond quickly to both government and local demands. Courses have to be relevant and focused on what patients need in the way of skills, knowledge and competencies, and in every setting - and they must be delivered quickly as people want safe services today!
The Working in Partnership Programme (WIPP) ( established in the new GMS contract to develop and implement a strategy for the effective use of clinicians' time, has invested in an initiative to facilitate the appropriate employment of HCAs. A fulltime project manager has been appointed, the steering group set up and the terms of reference agreed. We must start the business of initiating an energetic network, the production of helpful materials and the gathering of expertise, experience, energy and, yes, excitement.
There are already a number of general practices and PCTs forging ahead with planning and organising the healthy development of HCAs. The response from patients, nurses and doctors is overwhelmingly positive, and the benefits are palpable.
Nurses need not be precious about what they deem is their professional territory; they should be enthusiastic about spreading their skills and knowledge to others, thus ensuring that we reach all of the public and, as a result, enhance health and wellbeing. Florence Nightingale stated that the nursing role was primarily that of teacher, mentor, guide and leader. Nurses should be confident that, rather than compromise patient care, the HCA, if appropriately deployed, will bring major benefits to patients and colleagues. Nurses and doctors will be liberated so they can get on with the business of complex care, high-level clinical judgement and decision-making, and leading the team to spectacular primary healthcare. If we prove capable of such worthy ideals we will see a reduction of preventable hospital admissions, improved public health and the better management of long-term conditions. But most importantly, people will enjoy a higher quality of life.
Primary healthcare has experienced nonstop reform since 1999, but much has been achieved, so there are many reasons for nurses to feel proud of how far they have travelled. There is little more important in life than helping people improve their health, so keep going and warmly welcome new HCAs to your workplace.