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Clear career pathway needed

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On the 27 March, Independent Nurse attended the Role of Primary Care Nursing Summit held by Health Education West Midlands (HEWM) in collaboration with the RCN and the RCGP. The summit focused on the ways in which nurses in primary care can be invested in, so that they can ease the increasing burden on GPs as more and more care is shifted into the community.

The summit looked at how to develop the practice nurse workforce development, how best to provide national, regional and local information relating to practice nursing and clarify how practice nursing fits into the wider community nursing strategy.

Workforce crisis

There is no complete data on the primary care nursing workforce, however it is widely accepted that there are not enough nurses in the NHS. Many reports, including the ongoing Frontline First report commissioned by the RCN, have found that the numbers of community nurses have been in decline for the past five years. 1 The QNI and the RCN have both conducted work looking into the numbers of nurses and the data shows that the number of senior nurses has heavily declined, as well as the number of district and community nurses. This could be explained by an ageing workforce. A large percentage of the current workforce will retire in the near future and there are not enough younger nurses being recruited into primary care to cover the deficit.

This comes at a time when more nurses are needed to deal with the fact that people are living longer and require more involved and complex care.

Speaking at the summit, Steve Field, chief inspector of general practice from the Care Quality Commission (CQC), said there needed to be an increase of high quality nurses to care for the ageing population with long-term conditions. He said, 'I don't believe that you can serve patients without nurses in the practice. Jeremy Hunt needs to start acknowledging that there needs to be more nurses not just doctors.'

Moving forward

At the summit, a roadmap was given to every delegate with recommendations that have been put forward by a number of nursing figures on how to improve entry into and expand the primary care nursing workforce.

The roadmap was initially drafted at an event held in November 2013, which brought together Health Education England, NHS England, the Department of Health, the RCGP, the Committee of General Practice Education Directors (COGPED) and the Queen's Nursing Institute (QNI), with representatives from the 13 Local Education Training Boards (LETBs). The debate centred around the future of general practice nursing.

The roadmap outlines ways in which to sustain the practice nurse workforce. These include encouraging universities to provide students with placements in general practice, to have a clear career pathway into general practice and to implement a national training scheme for HCAs based on a recognised competence framework to training standards. Jenny Aston, the chair of the practice nursing forum at the RCGP, spoke at the summit about the roadmap.

Ms Aston said: 'GPs have a good training scheme and we need to ensure that there is a similar system for primary care nurses. We have been here before with other systems but now we need to keep going to make sure that these recommendations are implemented.'

'Nurses are the key to changing out-of-hospital care, but only with a standard of training applied across the entire workforce.'

Dr Peter Carter, chief executive and general secretary of the RCN, said that the UK still has a healthcare system where far too much of the resource is in secondary care. 'By not investing properly in primary care, every day we have thousands of unecessary admissions to hospital. With good primary care services we could prevent these admissions. At the other end of the spectrum where people have been admitted appropriately we now have the phenomena of delayed discharge so they stay longer than they need to.'

'In order to prevent this, we need to invest in primary care to ease the pressures on the rest of the system and improve out-of-hospital care.'

Better placements

Education plays a big part in the reasons why it is difficult to recruit newly qualified nurses into practice and community nursing.

The lack of sufficient placements in general practice and in the community means that many nursing students do not receive an informed experience of community nursing and thus are less likely to pursue it as a career.

Dr Carter said: 'I think that a greater emphasis on undergraduate training should be in primary care. Some universities do this very well, but in far too many a student might have one placement in primary care maybe into a heath centre or with a district nurse, which is fine, but it doesn't go anywhere near enough to produce a workforce that is properly educated to what a satisfying career you can have in the various settings in primary care'.

There is currently no clear pathway into practice nursing with clear education and clinical requirements.

The roadmap outlines the importance of creating a national framework to clearly lay out the entry requirements into practice and community nursing. The roadmap is an important document in setting out a series of recommendations to sustain the future of the general practice nursing workforce. It is important for the Department of Health, employers and universities to invest in the practice and community nursing workforce now in order to ensure that it remains functional in the future.


1. More than just a number March 2014 special report. RCN. March 2014. Accessed March 2014.

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