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GPN expertise ‘underestimated’ and ‘poorly articulated’, report finds

GPN expertise ‘underestimated’ and ‘poorly articulated’, report finds

Practice nurses have ‘vast’ and ‘complex’ clinical skills, knowledge and expertise that is ‘poorly articulated’ by themselves and ‘underestimated’ by others, research has found.

A report from consultancy Sonnet Impact and Sheffield Hallam University, looking at general practice in England, warned that raising the profile and value of the ‘misunderstood’ practice nurse role has become ‘urgent’ amid workforce challenges and the demand on primary care.

The research, undertaken in spring 2021, warned the NHS Long Term Plan must increase funding and renew focus on general practice nursing – particularly around education, training and leadership opportunities – to realise its full potential.

The findings also informed a framework (see box below) outlining eight factors – including enabling self-care, developing support communities and developing specialisms – where GPNs ‘drive value’.

‘Invisible’ GPNs

The report listed many ‘barriers to value’ for GPNs. These include practices not allowing them to access training because of the lost nursing hours, while many GPNs said they felt left out from conversations about primary care, with some citing no nurse representation on PCN boards.

Some nurses also told the report authors that others – including patients, the general public and other healthcare professionals – see them as ‘just a nurse’, while some participants ‘downplayed’ the full range and depth of their achievements until challenged, it found.

Yet it highlighted practice nurses are key to the delivery of the NHS Long Term Plan’s aim to better support the growing numbers of older people and those living with long-term conditions, as well as prevention and public health – as much of this is delivered by practice nurses. 

It also said a GPN is ‘often the one professional within the practice’ the ‘patient feels able to talk to informally’ in conversations where they may reveal key health information.

However, despite being a ‘key part’ of general practice, making up nearly a third of the clinical workforce and the second largest group after GPs, GPNs are ‘relatively invisible’, it concluded.

‘The myth that GPNs provide a handful of basic care and support services could not be further from the truth – the role has evolved over recent decades (often by ‘stealth’ and without full recognition) to one that forms the core of primary practice care delivery,’ it added.

Likewise, the report highlighted the variable terms and conditions in practice nurse contracts, which are made with the employing GP instead of being standardised across the NHS.

‘GPNs must be better understood’

Commenting on the findings, Dr Hilary Piercy, associate professor in the department of nursing and midwifery at Sheffield Hallam University, warned about the risk of ‘devaluing’ the role and ‘actively reducing the extent to which GPNs can bring about positive value to society’.

She continued: ‘The role of general practice nurses demands to be better understood – by nurses, by other healthcare professionals, by the general public and by decision makers in Government.’

Also commenting, Dr Crystal Oldman, QNI chief executive, said the analysis requires ‘close reading by policy makers, those who employ GPNs and anyone involved in commissioning and delivering population health in the community’, and will be of interest to all nurses in general practice.

Heather Randle, professional lead for primary care at the RCN, said: ‘This report highlights the diverse skills, expertise and leadership of the GPN and how key they are to the future of the NHS and general practice.

‘We must not underestimate the role they play in supporting their local population and the wider health economy including preventing hospital admissions and leading public health.’

Famework: How GPNs create value

Leadership – in multiple forms, including in clinical, management and development roles within the practice, regionally, and nationally; in making decisions and leading care across the range of general practice work; and in specialist fields

Networked approach – sharing expertise and insight both within and beyond the practice, so that patients get the care they need and that service delivery benefits from best practice wherever it orginates

Systems approaches and strategic prevention – understanding the progression of diseases, their causes and outcomes; designing and delivering education and prevention programmes; taking a health population view to improve health at community level

Improved diversity of access – providing a complementary and different approach to that of GPs and other healthcare professionals, that is more appropriate to some patients and situations

Supporting and enabling self-care – recognising that health conditions are mostly managed at home and supporting patients to play their part in staying well

Development of support communities – helping patients to tap into support from those around them, either by signposting or facilitating support

Skilled care delivery – competence and confidence based on robust training and a wealth of experience

Specialist areas of care – developing individual areas of excellence and responsibility.

Source: Quoted from the ‘Nurses in General Practice: What they do and why they matter’ framework

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