Expanding skill sets is the best way to cope with NHS pressures

Many of the duties of GPs can be taken over by practice nurses a report from the Nuffield Trust and NHS Employers has said.

The report, Reshaping the workforce to deliver the care patients need, found that nurses in primary care are capable of taking over more duties related caring for patients with long term conditions such as diabetes and chronic obstructive pulmonary disease. The report cites a study which claims that up to 70% of the work done by doctors in primary care could be performed by nurses and allied health professionals.

Expanding the number of advanced practice roles would also benefit the NHS. There are increasing opportunities for advanced nurse practitioners to bridge the gap between primary and secondary care, by providing specialist advice to GPs and playing a greater role in follow-up care. For example, employing advanced nurse practitioners in community mental health teams at Bradford District Care Foundation Trust has reduced admissions for patients in acute settings. However, the authors also noted that training advanced roles is expensive, and a lack of a clear competence framework could create issues with clinical governance.

Janet Davies, the chief executive of the RCN, also noted that many nursing staff do not have the time to expand their skills due to the changing nature of the NHS. 'Health service roles and the way people are trained for them must reflect this new reality and building a workforce to deal with these new challenges requires serious investment. Unfortunately, many nursing staff currently find it almost impossible to take the time to expand their skills as frontline pressures mean that many cannot be spared without there being an impact on patient care,’

she said.

The report also analysed the use of support staff could to carry out basic health checks on patients, allowing qualified nurses more time to spend on managing more complex cases. One example was of Bradford District Care Foundation Trust who employed four 'associate practitioners', to perform physical health checks for patients with mental health conditions, managed by an advanced practice nurse. More patients with serious mental illness were receiving physical health checks and getting better access to smoking cessation, weight management and support to control high blood pressure. The Trust received positive patient feedback on the programme.

'We looked at what skill would be needed in order to deliver the physical health check and after reviewing a number of job descriptions and things decided that we could go for something different, we didn’t need a qualified nurse, but we needed somebody that was competent and able to take physical assessments such as electrocardiograms and phlebotomy,' said a service manager at Bradford District Care Foundation Trust.

Candace Imison, director of policy at the Nuffield Trust said that the research shows that reshaping the workforce can can offer huge opportunities for patients and healthcare professionals. 'But we stress in our report that this is not simply a "nice to do" – it is urgent, and essential if the health service is to find a sustainable balance between available funding, patient needs and staff needs, and deliver services fit for the 21st century.’