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Breathing life into the Sonnet report

Kathy Oxtoby looks at the Sonnet report’s recommendations for the development of general practice
The Sonnet Report contains eight recommendations on how general practice can remain fit for purpose long into the future (Photo: Adobe Stock)

Healthcare is a sector full of reports with recommendations. But without action, these recommendations remain a list of points that are yet to be realised.

So when for the first time, the full extent of the general practice nurse role was explored in the Sonnet report, commissioned by NHS England (NHSE) and NHS Improvement (NHSI), Becky Wych, an advanced clinical practitioner and nurse partner at Combe Down Surgery in Bath, wanted its recommendations to mean more than words.  Ms Wych, who is also primary care nurse development lead, at BANES (Bath and North East Somerset) Enhanced Medical Services (BEMS)  – a GP federation – along with its chief executive Julia Griffith, set out to breathe life into the Sonnet Report’s proposals for the development of general practice nursing.

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By taking steps to realise the Sonnet report’s eight recommendations – and coming up with their own – BEMS has been raising the profile of general practice nursing in the area. A dedicated GPN Network recognised by system partners, an out of hospital nursing conference, and consistency in pay, terms and conditions are just some of ways the federation is valuing and developing GPNs.

NHSE and NHSI commissioned the Sonnet report as part of the General Practice Nursing Ten Point plan to research and write a report to encourage further investment in, and development of the profession.

The report argues for further investment in general practice nursing, and a sustained focus on education and training, career development, supervision, and leadership opportunities.

‘The report is welcomed by nurses across primary care,’ says Ms Wych. ‘It’s the first audit piece of work that really looks in depth at the role of general practice nurses and the contribution they bring to the communities they serve. And it comes at an important time for primary care nurses, who have felt for a long time that their voices haven’t been heard, and that they haven’t been valued,’ she says.

The Sonnet report ‘is a tool that helps us in primary care to understand the significant role that we play’, says Ms Wych. ‘Its recommendations help us to develop and progress the general practice nurse role for now and in the future. It’s about recognising that this role is unique, and that we have to value and treasure it, because without it there’s going to be great big gaps in care and knowledge across the whole of communities,’ she says.

A nurse since the age of 18, Ms Wych has worked in primary care for 20 years. As a nurse partner, and as primary care nurse development lead for the GP federation, ‘every day I can see the difference that practice nurses make. And it’s important for me to try and raise awareness about primary care nurses,’ she says.

When she saw an email asking practices to contribute the Sonnet report, looking at the role and contribution of practice nurses, she didn’t hesitate to inform BEMS and her GP practice that she wanted to get involved. The practice took part in interviews, including on how the role of GPNs was viewed.

After the Sonnet report was published in 2021, Ms Wych spoke to BEMS chief executive Julia Griffith about it. ‘Very often, for nurses there’s lots of words that come out of a report, and you think: “What does this mean for me?” We wanted to make the report real for people – to make it come alive,’ says Ms Wych.

‘We support what the Sonnet report says – that the practice nursing community doesn’t seem to have the profile it deserves nationally,’ says Ms Griffith.

‘It’s a good – very passionate – report. But we felt it needed an implementation plan,’ she says. ‘The report’s recommendations gave us some ‘hooks” on which to hang our thoughts and ideas.’ 

Sonnet report recommendations

BEMS analysed the eight key recommendations made in the Sonnet report. The report identifies a number of barriers that limit GPNs’ potential and if addressed could unlock innovative ways of working that will drive the effectiveness of the primary care system.

Its recommendations include a campaign to raise the profile of GPNs, support for the development of new pathways for newly registered nurses wanting to work in primary care, and that education and training programmes should reflect an enhanced understanding of the GPN role and how GPNs create value.

The report also recommends that GPN training courses should include modules to equip GPNs with entrepreneurial skills to support the practice as a business, there should be investment in a GPN professional support framework, and line management of nurses by non-clinical managers should be balanced by a professional support infrastructure across Integrated Care Systems.

Efforts should be made to ensure consistency in GPN pay and terms and conditions of employment, and GPNs should be actively recruited to key stakeholder groups such as PCN and ICS boards, the report says.

In response, in 2023, BEMS published its own report – authored by Ms Griffith and Ms Wych - into what is currently being done towards retaining and developing GPNs, as well as its own recommendations as to what can be developed in the future.

To help raise the profile of GPNs, BEMS has a dedicated GPN Network that is recognised by system partners, and has also worked with Wessex LMC to produce a podcast promoting GPNs at practice, PCN, and place/federation level.

Work to support the development of new pathways for newly registered nurses wishing to work in primary care has included helping to facilitate undergraduate nurse placements in primary care, and linking newly registered nurses to a GPN preceptorship programme.

‘We need to encourage students and other nurses to come into primary care, and to highlight the work that GPNs do,’ says Ms Wych. 

As part of ensuring that its education and training programmes reflect an enhanced understanding of the GPN role, business cases for the system are written that promote the role of GPN, GPNs are involved in the planning of new services or redesign of existing ones, and BEMS has developed GPN induction packs.

BEMS also hosted an out of hospital nursing conference that included nurses from GP practices, care home, and hospice nurses, who met together to discuss patient care and joint working.

BEMS has looked to make efforts to ensure GPN training courses contain modules to equip GPN with entrepreneurial skills to support the practice as a business. These include a nurse competency framework that has rough costs of the different grade of nurses that can be used by nurses in their internal business case in the practice. The federation has also hosted a GPN leadership programme in partnership with Education for Health.

To help provide GPNs with the resources, networks, information, and authority that they need to do their job well, as well as the GPN Network, BEMS’ website features a GPN page.

Regarding having in place for nurses a professional support infrastructure across the ICS, in her role as primary care nurse development lead, Ms Wych provides advice to practice managers about issues relating to GPNs.

To ensure consistency in GPN pay and terms and conditions of employment, BEMS offers the same rate of pay and terms and conditions to all nurses working in the same service.

And recognising the importance of actively recruiting GPNs to key stakeholder groups, BEMS has a GPN that attends the management executive committee (MEC), and both the BEMS Council and the B&NES Primary Care Collaborative have a GPN.

Ms Wych says GPNs need to have a voice in PCNs and at Integrated Care Board (ICB) level, for example. ‘It’s really important that nurses have the confidence, and are encouraged to participate on these boards,’ she says.

Ms Griffith would like to see more practice nurses getting involved with joining professional groups and committees. ‘If you think you don’t have a voice, you need to join these groups – and people will help you,’ she says.

Benefits and challenges of putting the recommendations into action

This focus on realising the recommendations of the Sonnet report has brought benefits. ‘There is an increased uptake of senior positions, including nurses on PCN boards,’ says Ms Wych.

She says that anecdotally, the approach is helping recruitment and retention of GPNs, and is also ‘helping morale as it’s raising nurses’ confidence’.

‘As the Sonnet report shows, GPNs make a huge difference and without them primary care would not survive.

‘Nurses know that, but it’s about giving them the platform and the belief they can maybe make a difference to their community,’ she says.

While finding the time to realise the Sonnet report’s recommendations can be challenging, ‘I believe that the passion nurses have will mean they are able to implement this’, says Ms Wych. However, she says one of the biggest barriers is ‘overcoming pre-existing ideas of what nurses are capable of, and what they can achieve’.

Having breathed life into the Sonnet report, there is still room for improvement. BEMS’ action plan is under review, ‘and we’re working through what more we can do. It’s about not standing still,’ says Ms Griffith.

‘We’re continuing to not let the Sonnet report die,’ says Ms Wych. ‘We’re still building on it, including by using social media to highlight the role of GPNs.’  And to the GPN community she says: ‘We all need to work together as a team to achieve what the Sonnet report recommends.’  


Kathy Oxtoby is a freelance medical writer