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WiPP General Practice Nursing Project Roadshow

Aoife Lynch
BA MA
Reporter
Nursing in Practice

The Working in Partnership Programme (WiPP) was set up in 2004 under the new General Medical Services (nGMS) contract to give general practice access to effective strategies and practical tools to help create capacity and increase the effectiveness of each consultation.
WiPP works in partnership with many professional and lay organisations so that nurses and doctors alike can benefit from shared experiences and have access to expert advice and previous directions taken in general practice.
The aim of the WiPP Project Roadshow was to highlight some web-based tools that WiPP has designed to help develop and integrate the primary care workforce. The WiPP General Practice Toolkit was highlighted as a method of navigation and reference resource in several areas, from employment practice to career
development.

The future of general practice in the NHS
Professor Nigel Sparrow, vice chairman of the Royal College of General Practitioners, asked why we need general practice, what we need to focus on at present and what the future holds for general practice in the NHS.
Professor Sparrow began by highlighting a few statistics about general practice, which illustrated just how important the local health service is to the community. Without general practice, we would have fragmentation of care due to multiple providers, and little aftercare or support in long-term illnesses would occur. Patients would become categorised by their diseases.
Professor Sparrow's overall message was that the GP practice is part of our local community and that the public have the ability to self-care and manage illnesses. Over 17.5 million people in England have long-term health needs. As our elderly population grows and major health issues such as obesity increase, that number will rise. On average, people in the UK see their GP three times a year, but if we had no general practice then people would go to hospital for treatment. Professor Sparrow was keen to remind us that hospitals are for the seriously ill and our GP practices should be taking care of everything else.
Further analysis of the cost-effectiveness of general practice highlights its importance and value for money. Consultation with a nurse costs £9, compared with £20 for a consultation with a doctor, £110 for Accident & Emergency and £300 for an outpatient visit. An Audit Commission report in 2002 highlighted what this meant to the health service. General practice accounted for 80% of all NHS activity yet only attracted 21% of expenditure.
Professor Sparrow outlined his vision of the role of general practice within the NHS - from improved access to care, integrated teams, more support for patients to self-care, to reducing the need for specialist referral, all of which can be achieved with WiPP guiding the way.

GROW diagram
One of the features of the WiPP Toolkit is the GROW diagram - a method of planning career advice and appraisal. Sue Cross, national project manager, WiPP, and Suzie Clements, nurse tutor and prescribing lead for North Herts & Stevenage, demonstrated how an appraisal can be carried out using the guidelines set out in the WiPP toolkit. Sue was conducting the appraisal and providing career advice to Suzie as a practice nurse.
First Sue directed Suzie to complete the GROW diagram (see Figure 1).(1) This allowed for a structured discussion and clearly lay down what it was Suzie wanted and where Sue could provide direction. The GROW diagram is a tool for developing a career path for the practice nurse. Suzie discovered a number of avenues open to her, such as lecture practitioner, nurse partner, and so on. The way forward was through qualifications and courses, all of which are outlined online with WiPP. The GROW diagram allowed Suzie to devise an action plan to achieve her goals, including the funding she would need. The diagram enabled Sue to see where Suzie had unrealistic or conflicting expectations that she could advise on. This toolkit gives directions on how to reach each level.
The diagram and toolkit also provided Sue with guidelines on to how to give an effective appraisal and what she should prepare beforehand. In this way both parties are informed and happy with the outcome of the appraisal.

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Difficult times
Kate Billingham, deputy chief nursing officer at the Department of Health, discussed the current difficult times and demands on funding. She put this down to:

  • The increasing levels of need due to issues such as obesity and unhealthy living, now evident as a serious problem.
  • Patients and taxpayers want and expect more.
  • The role of the expert has changed, and technology and science have changed.
  • Telecare and telemedicine, which are to make a huge impact on healthcare at home.

Kate's presentation reflected the feelings of many of the nurses at the roadshow. Nurses came out of hospitals and into general practice some time ago and are now branching out on their own as our healthcare service expands. While the tools and support given by WiPP are very valuable to those starting out in nursing, nurses who have been multitasking all along feel a little cheated. The courses are out there, but funding and time are still sparse. What practice nurse has the time to read websites, complete courses, get involved in mentorship and ask for a pay rise?
The nurses felt that their previous multitasking had been ignored and they had been thought of as dogsbodies. Nurses are now using opportunities to take control and set out on their own. The WiPP website and online toolkit is a starting point for nurses to see how they can develop their career.
Kate urged nurses to branch out, giving examples of how nurses have got more involved in social care and in the community. Kate gave an example of a nurse assigned to help a teenage mother nurse her child and at the same time help her to stop smoking.
She advocated nurses having their skills recognised and being given funding for courses to enhance and expand their skills.

Barriers and benefits of the WiPP website
The workshops looked at the barriers and the benefits of using the WiPP website as an aid in nursing and promoted the website as a competency framework within general practice.
Delegates discussed the difficulty in having the skills but not getting the recognition. The WiPP website contains information for nurses on courses and methods for obtaining funding. Tools such as the GROW diagram can be used to request more funding or training. A professional development plan created using this pack has worked for others.
The general practice workforce has evolved to enhance healthcare within our communities, and slowly nurses' abilities are being recognised. Nurses now have opportunities to influence the health service. Expansion has changed demands to include health promotion, family planning, treatment room services, minor illness management, triage, and management of chronic and long-term conditions, such as coronary heart disease, asthma and diabetes. The expectation is that GPNs
working in extended roles will:

  • Enhance the quality of services provided in primary care.
  • Safely substitute for doctors in a wide number of services, therefore reducing demand for doctors.
  • Reduce the direct costs of service provision.

In recognition of this, the WiPP Toolkit was commissioned and created to highlight good practice in relation to GPNs in the following areas:

  • Employment practice.
  • Education and professional development competence.
  • Integration with the wider community healthcare workforce.
  • Career development.
  • Quality improvement and evaluating practice.

Conclusion
This event brought nurses from a number of different backgrounds and locations together to discuss career development and nursing standards today and in the future. The WiPP toolkit generated a lot of discussion on the conditions of practice for nurses all over the country, with questions being answered and ideas swapped on how to develop careers in nursing. While many expressed difficulties in how they would manage to gain and fund qualifications while working with such heavy workloads, the examples of tools such as the GROW diagram set out by the experienced speakers showed a path to a brighter and happier nursing workforce.

References

  1. WiPP website. Available from: http://www.wipp.nhs.uk
  2. Chambers R, editor. Career planning for everyone in the NHS. The toolkit. Oxford: Radcliffe Publishing; 2005. Available from:
    http://www.wipp.nhs.uk/tools_gpn/toolu5_the_grow_model.php