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Scope of practice of GP nursing staff must be ‘clear and explicit’

Scope of practice of GP nursing staff must be ‘clear and explicit’

NHS England’s lead for primary care nursing has stressed the need to be ‘clear and explicit’ around the scope and level of practice of registered nurses and nursing associates working in general practice.

In a Royal College of Nursing (RCN) General Practice Nurse (GPN) Forum meeting in December, Louise Brady discussed the General Practice Core Career and Capability Framework and called on nurse leaders to support her latest ‘mission’ around this.

The framework, published by Health Education England in 2022, sets a standard on the scope of practice for nurses working within primary care and general practice settings. It includes three defined tiers for the ‘core capabilities’ of a staff member.

For example, nursing associates would sit under tier one – defined as having ‘capabilities that require a general understanding and that support provision of primary care/general practice nursing’.

Meanwhile, a registered nurse would sit under tier two – with ‘capabilities that enable the provision of care more independently and a degree of critical analysis’.

Advanced nurse practitioners would come under tier three – defined as having ‘capabilities that require an ability to provide care autonomously and independently, an ability to lead practice, operating at the cutting edge of innovation’.

‘So, when you think about activities in primary care, when you think about hypertension clinics, diabetes clinics, baby immunisation; the systems should be mapping their workforces’ capabilities to this published framework, because this is published guidance,’ said Ms Brady during the forum meeting.

Ms Brady, who also still works in a GP practice one day a week, has appealed to nurse leaders across the 42 integrated care systems in England to help map existing educational resources for nursing staff, against the framework.

Highlighting hypertension as an example, she explained how nursing associates, under tier one, would be able to understand ‘normal parameters’ and ‘sort out home blood pressure monitoring that comes in’.

But for registered nurses, sitting within tier two and three, they will be ‘managing hypertension, cardiovascular disease [and] lipid management at population health level’.

Ms Brady highlighted the need to be ‘clear and explicit’ at practice and primary care network level around the scope of practice of nursing staff in primary care settings.

She pointed to research from consultancy Sonnet Impact and Sheffield Hallam University which suggested the contribution of GPNs was ‘something of a well-kept secret’.

‘So, we need to start articulating our value and being very clear around scope of practice and level of practice across primary care and general practice,’ stressed Ms Brady.

Her comments come as concerns have been raised around the increasing substitution of GPNs with nursing associates in England – an issue which has been described as ‘devaluing’ practice nurses and their skills.

Meanwhile, outrage was also sparked after a report by the Care Quality Commission recently appeared to suggest there was ‘less need’ for registered nurses in primary care and that those in post could be replaced by nursing associates. This was later refuted by the CQC which said its wording had been misunderstood.

Ms Brady pointed to figures from NHS Digital which suggested there were 890 nursing associates working in general practices across England and 849 trainee nursing associates as of September 2023.

Evidence from NHS England suggests 50% of nursing associates will ‘top-up’ to become a registered nurse, she noted.

However, Ms Brady added: ‘We certainly haven’t seen that conversion in general practice in 2023.’

She said that ‘we need to encourage those 890 who are currently working within our general practices to consider the funded top up apprenticeship degree’.

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