It has been said that general practice nursing has finally 'arrived': that after years as an afterthought in decision-making in England, those in charge now understand and discuss how to maintain and strengthen these nurses' important contribution to the health service.
The appointment last year of general practice nurse (GPN) leads at NHS England, the Care Quality Commission, and HEE was tangible evidence of this, as was the integration of GPNs into workforce planning for the first time by HEE.
In the Shape of Caring Review, published by HEE on 17 March, we can see ideas on how to address workforce issues for GPNs begin to take shape as part of the wider nursing workforce. HEE's important GPN career and development framework and GPN education commissioning specification are included. The review also acknowledges the need to attract more nursing students to consider working in general practice, and discusses strategies to make this possible.
Lord Willis's proposed '2+1+1' model for pre-registration training seems particularly well suited for training GPNs. This model would see all nurses trained in 'whole-person' care in the first two years, with no specialisation in adult, child, mental health, or learning disability nursing until the third year. Lord Willis argues that all nurses need to be better equipped to deal with patients' mental, as well as physical, health needs, and require the flexibility to adapt to changing patient and workforce needs. In theory, this approach could see many more nurses better prepared for the 'cradle-to-grave' role of the GPN.
Lord Willis also recommends creating community nursing as a fifth specialty. He argues this would help address the problem that graduates are not prepared for working in general practice and other community nursing roles. This proposal lacks detail, but policy makers should be wary of the apparent attractions of the idea of one great flexible community workforce. Nursing in a surgery, in someone's home, or in a school, requires distinct skills for the range of services provided to patients in each setting. It might be a backward step to adapt the well-regarded health visitor/school nurse pathway to a three-year model as is proposed. Competences could not be taught in much depth if the third 'specialisation' year had to encompass health visiting, practice, district and school nursing. Graduates might not be much better prepared than under current arrangements to work in general practice.
HEE is building the foundations of a stronger career framework for GPNs, and there exist some good examples of how to prepare nurses for general practice. Thought now needs to turn to how to introduce these career and education models so they become embedded, with ongoing funding, and available across the country. If this does not happen, all the hard work will have been for nothing when the next round of 'reforms' come along.