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A new way forward for nursing

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District and practice nurses will have a clearer i District and practice nurses will have a clearer idea on how they can progress through their careers with the framework

A career pathway for practice and district nurses is finally here. After hearing whispers along the nursing grapevine, that a framework for primary care nurses was due for publication, Health Education England (HEE) released the document, District nursing and practice nursing service: Education and career framework.

‘Practice and district nurses have been crying out for a career framework, and so have employers because there was ambiguity and confusion around the skills needed to work in a general practice,’ says Marina Lupari, the outgoing RCN professional lead for primary care and community nursing.

With the help of a steering group made up of practice nursing leaders, academics and representatives from the Department of Health, NHS England and HEE, the framework aims to standardise the training and education of practice and district nursing across England.

What does it say?
The framework is split into two sections, one for practice nursing and one for district nursing. Each section then divides into nine distinct levels, similar to the bandings seen in Agenda for Change, although the framework’s levels will not be linked to pay grades.

The pathway starts with healthcare apprentices and assistants at levels one to three, while advanced nurse practitioners and nurse consultants are levels eight and nine respectively. The document sets out the educational and professional requirements to progress through the levels.

‘For the first time, we will have a framework that gives practice and district nurses
the opportunity to work from level one right to level nine.’ Ms Lupari says. ‘On the one hand it will give nurses
a clearer direction and more understanding of what it means to be a nurse with a skill set of a level six practitioner in primary care. We’ve never had this before.

‘But additionally the framework also offers a clearer understanding to employers in primary care, on what it means to be a nurse practitioner, practice or district nurse or nurse consultant.’

For nurses to move up the scale, additional professional and clinical skills will be required. For example, a level eight nurse practitioner will have to display competencies in areas such as leadership and management of a practice team, as well as the capability to prescribe.

How did it come about?
The initial idea came from the Transforming Community and Primary Care Nursing initiative from chief nursing officer Jane Cummings. It began as a joint document looking at the training requirements of both district nurses and practice nurses. However, as the framework began to develop it became apparent to the steering group that district nurses and practice nurses are two different work streams with varying skills.

This led to the framework being split into two to represent each type of nurse separately. The work has
been in development for over a year, and involved a lot of workshops and engagement with frontline staff.

‘I think in terms of the framework, we recognised two and a half years ago that community nursing was going to be pivotal to the way in which care was delivered in the future,’ Lisa Bayliss-Pratt, director of nursing at HEE, says. ‘We are already trying to get more patients seen in primary care, to prevent more unnecessary admissions to hospital.’

Recent documents such as the Roland report into primary care services and the Five Year Forward View have reinforced the message that primary care nurses are going to be a key workforce in carrying the NHS forward.

What will this mean for nurses?
With the renewed focus on boosting preventative services in primary care, practice and district nursing is increasingly in the limelight. The new framework has been designed to allow nurses to develop their skills and advance professionally in a more structured manner.

‘It is important that the framework isn’t used as a stick to beat people with,’ Ms Bayliss-Pratt says. ‘It should be an enabling and liberating thing and it will help people articulate their learning and development needs and demonstrate competencies.’

Ms Lupari says that the creation of the framework should boost the numbers of student nurses who begin their careers in general practice settings. She believes that it will give the opportunity for induction and developmental plans to be created to support that nurse in their career in primary care earlier than they currently do.

‘Alongside this we are producing education specifications, which is going to allow nurses to come out of university and go straight into primary care. Primary care has historically been seen as a setting that nurses will go into later on in their career.’

She also thinks that, on the other end of the scale, it will provide registered nurses with opportunities to advance their careers. ‘For registrants, it will provide further career opportunities for those with skills such as clinical leadership.’

Ms Bayliss-Pratt also thinks that the framework will allow practice nurses to secure training and education opportunities that they may have previously been unable to access. ‘The tool can be used as an opportunity to have a conversation with managers to say they want to develop these knowledge and skills.

‘Here are the benefits to the patient, to community, and the population we care for. They should be able to use it as a lever to articulate the learning and development they want in order to progress further and do their job at a different level.’

How will it be taken forward?
Now the framework has been published, the next steps to ensure maximum impact will be crucial. Ms Lupari says that it is important that this becomes a viable tool that doesn’t just sit on someone’s bookshelf or is uploaded on a website that isn’t accessed by anyone.

‘Implementation is even more important than the development,’ says Ms Lupari. ‘So the next question is how
is that going to happen and how are nurse educators going to use this in their programmes for students. And how are employers going to ensure the nurses working in their practice are competent. What will be the communication strategy for GPs and how do we communicate this to nurses?’

Lynne Hall, the clinical project lead for community nursing at HEE, says that there is a communications plan that will be linked with the launch of the framework. ‘What will accompany the launch will be an education commissioning specification solely for commissioners, to implement the education and training within the document,’ she says.

She said that GPs will be targeted to make the launch more inclusive. ‘We’ve got a comprehensive list of stakeholders. Each CCG and GP practice in the country will be sent a copy of the framework. It has been discussed in principle at the Royal College of General Practitioners (RCGP) conference and it has been well received.’ Ms Hall also says that there will be a Tweetchat hosted by @WeNurses at 8pm on 3 November to discuss the framework.

The general practice nursing group from the RCGP has refreshed their practice nursing competencies which complements the framework.

Ms Bayliss-Pratt emphasised the scale of the prospect the framework presents for practice nurses and the profession as a whole. ‘This is a fantastic opportunity. [The framework] is being identified as an incredibly valuable resource to deliver high patient care to be seen pivotal to the future. I’d like nurses to really embrace the concept, and use all that we’ve got to be the best we possibly can,’ she says. ‘We are an incredibly dynamic, flexible workforce and we can be trained relatively easily. We can be up skilled, reskilled and introduced to new environments so my message is let’s not miss this, let’s seize it and forge forward.’


1. District Nursing and General Practice Nursing Service. Education and Career Framework. Health Education England. October 2015.

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At last, a fantastic framework to encourage safe and fair practice amongst primary care nurses. I just hope GP's will take it seriously and stop the employment of nurses who are given roles and titles which poorly reflect their skills and qualifications and which leads to misguided expectations by patients. This framework, however, is just the beginning and primary care employers must deal with 1) unfair pay scales 2) SEVERE lack of funding and support for training and educational achievement 3) employment of nurses who are given roles, titles and responsibilities which they are clearly ill equipped to fulfil and this results in unsafe practice (often naively keen and salary doesn't dent the budget too much) 4) serious plans put in place to employ young/newly qualified nurses to replace the ever increasing aged workforce within primary care WITH funded training programmes to support this transition. I'm delighted to to see this framework being established and just hope that the 'powers' can support and enforce it. If it is left as an optional consideration then, if i were a betting person, i would certainly not put my money on it being taken seriously and implemented. I do so hope i am proved wrong!
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