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Updated: Outrage as report appears to suggest ‘less need’ for GPNs

Updated: Outrage as report appears to suggest ‘less need’ for GPNs

General practice nurses (GPNs) have been left outraged after a new report by the Care Quality Commission (CQC) appeared to suggest there was ‘less need’ for registered nurses in primary care and that those in post could be replaced by nursing associates.

However, in a statement issued to Nursing in Practice this afternoon, the CQC has refuted the suggestion and said nursing associates were being used by some local authorities, ‘overseen by registered nurses, for tasks that do not require a registered nurse to complete’.

The CQC’s latest annual report on the state of health and adult social care in England was published today – uncovering fresh concerns about the detrimental impacts of escalating workforce pressures and the cost-of-living crisis on patient care across the country.

In a section related to ‘workforce risks’, the CQC claimed local authorities had reported ‘working with service providers in different aspects of workforce development and recruitment’.

And as part of this, it suggested authorities were ‘working with primary care on nursing associate roles where there is less need for registered nurses’.

Concerned about the potentially damaging narrative, GPNs and those among the wider nursing community have taken to social media to condemn the statement which they feel shows ‘blatant disregard’ for the work of nurses in general practice.

Chief executive at the Queen’s Nursing Institute Dr Crystal Oldman told Nursing in Practice: ‘It is unclear on what basis the CQC believes there is less of a need for registered nurses in primary care.

‘It is in fact quite the opposite with general practice requiring more not fewer registered nurses.’

She added that GPNs ‘play an indispensable role in primary care, as is well evidenced’.

‘Nursing associates are not a substitute for the expert work of the general practice nurse,’ she warned.

Drawing attention to the issue on X (formerly known as Twitter), Professor Alison Leary, Professor of healthcare and workforce modelling at London South Bank University, wrote: ‘Why is the new [CQC] report stating that there is less need for registered nurses in primary care and suggesting they can be replaced with nursing associates?’

The Royal College of Nursing (RCN) GPN Forum replied: ‘This blatant disregard for the millions of consultations provided by GPNs and sheer lack of understanding of the role of a GPN by [the CQC].’

The forum stressed the situation ‘needs immediate escalation’.

Meanwhile, one GPN said the wording used was ‘horrifying’, adding that GPNs ‘already feel massively undervalued’.

Another GPN wrote: ‘GPNs are the most holistic and multi-trained professionals in general practice.

‘This is utter rubbish. Splitting the role into smaller ones does not make an effective, safe environment for patients. I am astounded at this short-sightedness.’

In addition, Labours nursing advisor Ann Keen wrote: ‘This is so serious and has to be challenged.’

CQC responds

However, in a statement issued this afternoon, a CQC spokesperson said: ‘To be clear, we do not say there is less need for registered nurses.

‘This section is reporting on what different local authorities have said they are doing regarding workforce development in their areas.

‘One of the examples of things that local authorities said they were doing around workforce development was using nursing associate roles, overseen by registered nurses, for tasks that do not require a registered nurse to complete.’

The nursing associate role, launched in England in 2017, is defined by the Nursing and Midwifery Council as bridging the gap between health and care assistants and registered nurses.

Nursing associates are one of 17 roles covered by the Additional Roles Reimbursement Scheme (ARRS) – a programme introduced in 2019, which allows primary care networks to claim reimbursement for the salaries of some multidisciplinary roles into practices. GPNs are not included in the scheme, though advanced nurse practitioners were recently added.

As reported recently by Nursing in Practice, concerns have been raised around the impact of ARRS roles on GPNs, including that GPNs are having to develop induction programmes for ARRS staff coming in and supervise those in post, but without recognition or benefit.

Early research carried out by the Queen’s Nursing Institute found more than half of GPNs surveyed about the scheme said they had not been able to give more holistic care since ARRS roles were implemented, and a majority said their workload had not decreased.

In a recent interview with Nursing in Practice, QNI chief executive Dr Crystal Oldman warned GPNs were being ‘airbrushed out’ and ‘ignored’ by key stakeholders and national policies.

This story was updated at 15.30 on 20 October to reflect a statement from the CQC


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