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'We can invest in both the future and current workforces'

Chief nursing officer for Health Education England Professor Lisa Bayliss-Pratt and deputy chief nurse Liz Fenton talk to Alice Harrold about the new nursing associate role

How do you think the nursing associate role will affect things when the first round qualify next January?

Lisa Bayliss-Pratt We have already got 2,000 nursing associates in the system now, and we are aiming to recruit 5,000 this year. Many nursing associates can use a work-based learning model with their current employers. So what we are finding is that people are actually working with their existing workforce and skilling them up. Generally, these are people that haven’t worked within these environments. It’s not an either/or situation between investing in the future workforce and in the current one. I think it’s about upskilling all aspects of the workforce. And with the nursing associates – because they have already got care experience in the main and worked with a support worker – the training they are getting is helping them quite quickly to become an enhanced member of the multidisciplinary team. And they are not a drain on the resources that are already out there, and certainly within general practice I have seen great examples of investment in the whole team. So GPs, nurses and the phlebotomists — it’s a lot of joint training that can happen. And we have obviously got our own training to help in that process. So I think it’s important that we don’t just look at training in silos, but look at it in teams and how it can be done together a lot more.

It’s not an either/or between investing in the future workforce or the current one, there are lots of common competencies that the whole team need to learn, and that can be done together in many cases. 

FACT FILE: Lisa Bayliss-Pratt
  • Chief nurse for Health Education England since October 2017 and director of nursing since 2012
  • Assistant director of nursing at Midlands and East Strategic Health Authority from 2011 to 2012
  • Practised as a nurse in emergency care and surgery

I know one worry shared by a lot of our readers recently was about the safety critical medications that nursing associates will be expected to use. What would you say to ease these concerns?

LBP We published guidance in February on how nursing associates can safely administer medicine, and if organisations read and apply that guidance to their practice, then there’s no reason to be anxious about nursing associates being trained and able to give medication. It’s important that employers take responsibility for identifying their safety critical medicines and make sure that, if nursing associates are going to be administering them, they are properly trained. Everybody must be clear about what training they have had and what assurances the employers have got that the person can administer safely. And most importantly, that all those checks and balances are in place if you are also monitoring patient outcomes. There’s very little guidance out there on medicine per se, and what people need to do is take this guidance and use it and utilise it. You should always be looking to see what people can do, as opposed to what they can’t. And, of course, to be safe and effective — that is my message and my advice to any practitioners who are grappling with this. 

When I think about community nursing and primary care, I know that a lot of the time many patients are giving themselves or their carers a safety critical medicine. So we have got to look at this holistically and not take a reductionist view. At the end of the day, it’s all about trying to give holistic, patient-centred care. And that will mean different things to different people depending upon their health and wellbeing, and their ability to care for themselves.

What kind of professional support can our readers expect as the NHS works to move more care into the community? 

FACT FILE: Liz Fenton
  • Deputy chief nurse for Health Education England since October 2017
  • Specialist advisor to the Care Quality Commission since 2010
  • Executive director of nursing at Gloucestershire Care Services NHS Trust from 2013 to 2015
  • Registered as a nurse in 1981

 LBP I think we can provide you with the exact detail. The £15 million investment, led by  our chief nursing officer for England Jane Cummings, has been a fantastic opportunity  to really promote and encourage nurses who would like to work in general practice.  There are opportunities to do so, so we are working with the Ten-Point Action Plan and  want to encourage people into general practice from return-to-practice initiatives. In  2014 we published a general practice nursing framework, and looked at the different  competencies within district nurses and general practice nursing. Now the fantastic  thing about this is that it identified the competencies needed to work in general  practice. And there are many of them that are complementary to district nursing and,  therefore, there are people who feel they can do both district nursing and general  practice nursing roles. And that very much has helped us with our community nursing  review, which Liz Fenton is leading. 

 Liz Fenton This is work that we are just starting. And we are billing this as beginning the  conversation about community nursing across England. We want to find out what  providers, service users, commissioners and others consider to be the skills and  knowledge that we require in a contemporary community nursing workforce. Part of that is recognising the huge advantage that has already happened within community services. We no longer think about acute care happening within a hospital, and potentially moving to a position where even more of that will be provided either at home or within the primary care setting. We are starting those conversations now – we had one in London towards the end of February and we have another in Birmingham at the start of March. Part of the reason for us doing that was because we have positive commissioning intentions in the number of training programmes that we commission at Health Education England (HEE) — but we were seeing a decline in the uptake of that. There were a lot of anecdotes about why that decline might be, so what is really important to us is turning those anecdotes into real evidence. So we think about what is the right way to develop and educate the community nursing workforce of the future. 

What sort of anecdotes were you hearing?

LF It varies very much in different parts of the country, some were about the applicants, the number of applicants and their ability to meet the criteria for the programme. Some were about the ability to get release from practice, from others we heard that perhaps it wasn’t such an attractive career and that people didn’t have the understanding of these roles to make it an attractive opportunity. So we really wanted to delve into that a bit deeper and understand why.

LBP I think what we are finding and learning is that it’s worth mentioning that we have got this draft workforce strategy in development. But the key thing within that, in particular around what does the model employer like, is how do we create careers and not jobs. How do we value the workforce, and what does it mean to them? What we are finding with return-to-practice nurses that want to go back into general practice, is that it’s an attractive opportunity for them. Because they are quite flexible in what they can do and we know that is one important factor for parts of their career. So because general practice can offer flexible hours in some places, and because it’s very much focused on population-based health, the nurses in those environments will quickly go into autonomous roles with the right training, such as leading clinics and helping people with long-term conditions to live better. General practice nursing has almost become a vanguard of what many people are telling us they want out of a career in health. You would think the nurses would be there for the taking because general practice offers many of those things that a lot of people are telling us they want in order to stay in the profession, and therefore building their work.

I know that our readers love their jobs, and everything you have said about getting to see the whole of the patient and the community in their roles. A concern a lot of our readers have is around pay, and so what advice would you give to our nurses who maybe are feeling underpaid at the moment?

LBP Yeah, I think pay is a priority that HEE has never really gone in to because it’s not within our remit. But I think so. It’s difficult for us to answer to be honest because it’s not something we deal with. And from an education and workforce point of view, this role and its potential and the fact that it can be seen as a leader around population-based healthcare delivery is most certainly at the forefront for many people. There’s an initiative in west London in a place called Cuckoo Lane Practice. Where actually the practice nurses are running the show, and the trusts are actually taking on the role of running the practice and generating income to the various activities that they do to improve the health of the local population.

I haven’t been but I know the two practice nurses, who are the partners. It’s a wonderful initiative that they have set up there. So do you think maybe more nurse leadership in primary care might be a good avenue to go down?

LBP The fascinating thing is that they are running the show, they are leading, they are managing and they have got entrepreneurial skills clearly to do that. So what is it that we could learn from them to enable us to do the same. What they tell me about Cuckoo Lane is that they are being paid an hourly rate that they think is worthy of them. They are actually setting the rates and are encouraging the nurses to leave the Agenda for Change. I don’t know how their funding works, but obviously they are kind of entrepreneurial. There are nurses like that all over the country leading a lot of the work and clinic but not being stifled by pay terms and conditions. They are certainly not feeling at the mercy of others, but they are actually crafting their own careers and they are getting job satisfaction along the way. 

LF Yeah absolutely, there are many examples across the country of nurse partners in primary care. And I think that example of leadership is strengthening and is one of the key themes in the joint work we are doing with NHS England around this additional investment into general practice nursing. We are investigating ways we can strengthen that nurse leadership. And, in doing so, support the development of those nurses in practice.