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‘Top-down culture’ in GP practices during Covid left nurses ‘overlooked’

‘Top-down culture’ in GP practices during Covid left nurses ‘overlooked’

A ‘top-down culture’ adopted by many general practices and primary care networks (PCNs) during the Covid-19 pandemic left nurses feeling undervalued, overlooked and unable to make valuable contributions to service design, a new study has suggested.

Researchers at the University of York conducted interviews and focus groups with 40 nurses across England to understand how working during the pandemic had affected their wellbeing, as well as the factors that contributed to job dissatisfaction.

The study revealed that many had considered a change of career as a result of their experiences.

The research, funded by the General Nursing Council for England Trust, found that decisions on reshaping general practice services during the pandemic were taken by GPs and practice management with little input from nursing staff, despite the large part of their work involving face-to-face interactions for the duration of the crisis.

While some of the study participants had influence over the structure and organisation of their work, this was not universal.

‘Most practices and primary care networks adopted a top-down approach in which nurses had little involvement,’ the study said.

‘Participants felt undervalued, overlooked and unable to make valuable contributions to service design.’

Authors also reported there was ‘sometimes a culture of fear about whether participants, because they are nurses, would be supported in times of adversity or if something went wrong’.

In some practices, nurses were excluded from clinical meetings, ‘huddles’ and other aspects of support that were put in place for GP colleagues, it said.

Some did not receive the same IT training and reported a lack of technological equipment, and as participants continued seeing patients face to face, their personal safety was sometimes not risk assessed.

At some practices, participants also felt in-person work was deflected onto them from other members of the multidisciplinary team and they reported that their wellbeing was not perceived to be important.

Many nurses reported an impact on their mental health, and some faced burnout. This led to nurses leaving general practice, or the nursing profession altogether.

In addition, many participants did not receive equitable pay, terms and conditions compared with their NHS-employed nursing colleagues, leading to disparities in pensions, maternity and sick pay.

Meanwhile, study participants also reported feeling that their work on setting up Covid vaccination centres and administering vaccines to patients went unrecognised by colleagues, the media and the general public.

Dr Helen Anderson, from the University of York’s Department of Health Sciences, said: ‘Despite considerable changes to general practice during Covid, which saw new technological interventions and an increase in phone and online consultations, much of the work that nurses carried out simply had to go ahead in-person, but against a backdrop of considerable stress, anxiety, and health risks, much of which has been undocumented in research on the pandemic so far.’

She added: ‘Many of the nurses we spoke to told us that they felt “forgotten” pre-pandemic, but that this was further exacerbated during Covid-19, which led to nurses feeling undervalued and accelerated considerations to move out of the profession.’

The findings of the University of York reflect recent comments by Dr Crystal Oldman, chief executive of the Queen’s Nursing Institute (QNI), who told Nursing in Practice earlier this year that the work of general practice nurses (GPNs) is being ‘airbrushed out of everything’ and leaving a damaging and lasting impact on their morale.

Similarly, Paul Vaughan, vice chair of the Royal College of Nursing (RCN) recently told a Labour Party Conference event that GPNs are not being properly ‘recognised or rewarded’.

In recent weeks, the RCN has urged the government to provide additional funding to ensure GPNs receive the full 6% pay uplift promised in the summer, as some risk missing out.

And GPNs were recently left outraged following a report by the Care Quality Commission that appeared to suggest that 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 healthcare watchdog.

According to Dr Anderson, the University of York study revealed ‘three key areas’ that could make nurses feel more valued in their position.

‘A key factor is being included in decision-making on significant changes to general practice,’ she said.

‘The second is for management to demonstrate understanding of the roles that nurses have, and remunerating them appropriately, as it was often pointed out to us that colleagues seemed to be unaware of what nurses were doing on a daily basis.

‘Lastly, it was important to our study participants that there was more awareness raising of the “invisible” role they play with colleagues, the media, and general public, to improve understanding of the highly skilled work that they do.’

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