NHS England’s chief nursing officer Jane Cummings on nursing associates, the nursing bursary and why everyone should be grateful to practice nurses
Primary care and community nursing are feeling the pressure of an ageing population, an increasing shortage of staff and cuts to funding.The Government’s response has been to introduce new roles and ways to train, but what will this mean for the nurses who are currently at the forefront of services?
NHS England’s chief nursing officer (CNO) Jane Cummings spoke to Nursing in Practice, sharing her thoughts on the latest workforce developments and her message to practice and community nursing professionals. Most of all, Cummings wants to encourage nurses to take a ‘step back’, to recognise all that they do and take time to think differently about the pressures they are under.
What is your message to practice and community nurses?
From a personal point of view, I just want to say thank you to those that are working in primary and community care. I am very conscious that the vast majority of the publicity about the health service talks about acute hospitals, but we know that the vast majority of patient contact is in community settings and primary care.
So, I want as CNO to say thank you to those people that are working in those areas and to recognise the pressures they work under, and also to say that we are actively looking at how we can support those parts of clinical practice, and work with practice nurses, community nurses and others, to enhance what they do and make their jobs as meaningful and interesting, and as recognised and supported as possible. So a big thank you from me.
What is your vision for the future of primary care?
It is linked to the Five-Year Forward View. I see primary care in the future as based around personalised care, working in an integrated way with other health and social care organisations to provide care wrapped around individual patient needs. Nurses will play an increasingly big role in supporting people to not only help them with supported self-care, but also enable them to identify early when things are getting worse or they need support and help. We need to wrap services around patients in community settings. Hospitals are important, we absolutely need them. But people should only be in hospital when they absolutely need to be.
In order to do that, we need to invest more in community and primary care so that we’ve got people with the right skills and experience to support patients in their own homes. When I say their own homes, that means care homes and nursing homes as well as their own house or bungalow or flat.
Do you feel that the investment for practice nurses that’s been offered in the GP Forward View has actually materialised?
The investment is definitely there. What we’re doing at the moment is developing our plans for how we will spend it. I was very pleased to see practice nursing was recognised in the GP Forward View.
I think we have an increasing number of GPs who are absolutely supportive and recognise the fantastic role that nurses can play. We obviously have the Care Quality Commisson (CQC) making positive statements about some of the fantastic practices that are either run by nurses, or have significant amounts of advanced nursing practice in them.
I want to see practice nursing recognised as a fantastic career option; I can see it as something really powerful in the future. If you think about the Five-Year Forward View and the triple aim of trying to improve health, wellbeing and quality while making the best use of the resources we’ve got, the role of practice nurses in the future is phenomenal. They should play an active role in providing that care to the people in their own communities.
I’m quite excited about the opportunities that we’ve got with community and primary care to drive the changes that front-line staff often say they want.
What you think can be done about low morale and burnout in the workforce?
The key thing for me is recognising how exceptionally busy people are, and also saying ‘thank you’. Being thanked for the effort that people are putting in day in, day out is important and something we should really do. It is important to speak to staff about what matters to them and make sure they have an opportunity to perhaps take a bit of time out, do something that gives them a break.
There’s quite a lot of evidence about things like the Schwartz Rounds compassion initiative and wellness and mindfulness. Although some people may not agree with them, they do help people step back and have a bit of time to think differently about some of the pressures they’re working under and reflect and recognise some of that. And it’s also down to individuals to work together to recognise when people are really pressured and stressed, whether that’s colleagues supporting each other, or practice managers, GPs, other general practice staff or clinical commissioning groups; making sure people have an opportunity to talk.
How do you think the introduction of nursing associates is going to affect community nursing?
Nursing associates will provide additional support and flexibility to the workforce in community settings and certainly it’s what a lot of people have been asking for. The opportunity for individuals to have a different career pathway that enables them to get more education and support and to work at a higher level is one that will be welcomed, and will provide additional flexibility and support in community settings.
But it’s also important that we recognise that although this is about developing a contemporary workforce, they will work under the direction of a registered nurse. It’s really important that we all recognise that a nursing associate is not a nurse. But actually, nursing associates will be able to support registered nurses to spend more time on the assessment and care of more complex patients.
When you think about the pressures and challenges that
people are facing in all parts of the NHS and care system, and particularly in primary and community care, that additional support and expertise should benefit patients and general staffing quite significantly.
The postgraduate diploma students starting in September are going to keep their bursary. Do you think this should continue in the coming years?
We need to make sure we have a flexible approach to staffing and the right numbers in the right place at the right time. And some of that is wider than undergraduate education and the routes to becoming a graduate nurse. Some of it is about how we retain staff and enable them to be the best they can possibly be, and how we actively respond to what matters most. And that’s a key focus of our nursing and midwifery framework – needing change, adding value – it was one that we also included in compassion in practice, recognising that what staff say matters to them is really important for us all to focus on.
Do you think if the postgraduate bursary is scrapped, it will impact the workforce in terms of losing a key demographic with that experience?
Yes, there will be some uncertainty with those people who already have one degree who want to then do a second degree to become a nurse or a midwife. We need to look at what that does. We know the average age of graduation is something like 28-29, so quite a lot of people go into nursing later than a lot of 18-year-old students do, so it’s something we need to monitor very carefully.
Will scrapping the bursary in England have a negative impact on nursing workforce numbers?
It’s too early to say at the moment. One of the things that I’ve said publicly is that the bursary changes are unchartered territory. We know that in some parts of the country, universities receive applications from a lot more people than they can accommodate in their training programmes. But I think there will be a reduction. Whether that reduction is the same across the country and in all fields of practice remains to be seen. For example, the reductions in learning disability and mental health might be more than reductions in paediatrics, because of the nature of the individuals that apply to become nurses in those fields.
Most people are saying that, while there may be a dip, the numbers might pick up again. I think the point about the apprenticeship model to become a graduate nurse is to give people flexibility so there are different options. So it could be that you go through the nursing associate route, or the nursing apprenticeship route, or directly into university. At the end of the day, every one of those nurses who graduates will graduate with a degree – they will gain it in a different and more flexible way than in the past.
It’s something we need to monitor very carefully, and if we get the ability to take more students into education, and therefore be able to provide a greater pipeline for people to become nurses and midwives, for example, that might help. But it is, at this moment in time, probably too soon to be clear how it will work.
We’re working together to look at what the figures show as they come through, and then we will work through what the implications are. The good news is that we know that there are still many people who want to become nurses and midwives and it is a fabulous career. It’s very busy, very challenging at the moment, but it is everybody’s business to talk positively about what a brilliant option this is as a career.