Investment in ‘teams not princes’…

Investment in ‘teams not princes’…

I’ve thought long and hard about whether I should challenge the General Practice Nursing (GPN) 10-point plan because if general practice nurses feel like the ‘Cinderella’ of nursing then do they need a prince to save them from their world and is the NHS GPN 10point plan that prince?

The plan states that the following 10 actions will or should support recruitment, retention and retraining of general practice nurses.

  1. Celebrate and raise the profile of general practice nursing and promote general practice as a first destination career.
  2. Extend leadership and educator roles.
  3. Increase the number of pre-registration placements in general practice.
  4. Establish inductions and preceptorships.
  5. Improve access to ‘return to practice’ programmes.
  6. Embed and deliver a radical upgrade in prevention.
  7. Support access to educational programmes to deliver national priorities as set out in the Five Year Forward View.
  8. Increase access to clinical academic careers and advanced clinical practice programmes, including nurses working in advanced practice roles in general practice.
  9. Develop healthcare support worker (HCSW), apprenticeship and nursing associate career pathways.
  10. Improve retention.

Do we as champions of primary care think that will work?

I started practice nursing in 1988 (I know, I don’t look that old) and colleagues from the acute trust I worked in at the time said, “Don’t do it, GPs are terrible employers. You won’t have your NHS pension and there is no career progression”.

In many cases they were right. There are some terrible employers and I didn’t have my NHS pension for a while and, at the time, there was no career progression.

However, I worked every day in a fabulous multi-disciplinary nursing team where we supported our population. The health visitor helped run well women clinics and, together with the district nurse, I managed home visits. With the other practice nurses, we ran clinics for prevention, chronic disease, travel and immunisations.

We got to know our population as individuals but also as part of a family. We could see the impact of poverty on health and on families and we could moderate our work to meet their needs. I know this wasn’t the case for all my colleagues because we met at practice nurse meetings and talked about our work.

Changes in health service over time have diluted this teamwork and we have separated teams into contracts and contracts into key performance indicators but have we really improved outcomes in the community?

Workforce challenges are across all care sectors but in particular general practice has struggled to retain, recruit, and retrain nurses. This means we need to promote community and primary care as a career option and not just nursing. We need to develop effective teams and not just concentrate on individual roles.

Patient safety research shows that, even though investigators into serious incidents often identify communication as an issue in many care failures, patient safety failures are much less frequent when great teamwork is in place. However, when we look at the investment in training and development, it is often at an individual level.

The 10-point plan doesn’t address team development nor does it address population health need. It does not address the issues around small practices where GPNs often work in isolated roles and are often exposed to working in unsafe environments, where there is no integrated team working and where competence is stretched. The data from the Care Quality Commission (CQC) and the General Practitioners Committee (GPC) show more quality concerns in small practices than in larger groups.

Employment remains an issue for some GPN colleagues. Will the employer (usually the GP) let them go on courses, will they develop career options, will they support multi-disciplinary team working? Will this plan help the fundamental issue of confidence to lead the change for themselves?

The National Association of Primary Care (NAPC) is trying to address the development of effective teams in the primary care home model: to improve population health delivered by integrated teams working in accountable systems. I am not against a focus on GPN but I think we need to accept that we are in danger of robbing Peter to pay Paul in workforce terms unless we address team development and service change.

Back to Cinderella – in my youth I probably would have been looking for a prince (or princess) to ‘save me’, however, now I am looking for a great support network to help with life and the complex challenges we face. The limited precious resources we have in the NHS need to be spent where we know we will make most impact – teams not princes.

Julie Bolus
NAPC Executive Member

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