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Nurse leaders must drive integration, says senior nurse

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'Doctor-centric' approach is not working 'Doctor-centric' approach is not working

Nurse leaders must seize opportunities to develop an integrated approach to the general practice workforce, a leading primary care nursing figure has said.
Marina Lupari, professional lead for primary care and community nursing at the RCN, told Independent Nurse: 'The time has never been better for nurse leaders to drive forward development of an integrated general practice workforce, using the evidence base and existing good practice to try and test it in England.'
Her comments were made in response to the document Building the Workforce – the New Deal for General Practice, jointly published by the BMA, the RCGP, NHS England and HEE. The document referred to ensuring a skilled and motivated general practice workforce for the future. It focused on how more GPs might be recruited and retained in general practice, how the workload of GPs can be eased, and career paths improved. Primary care nurses were mentioned once.
Ms Lupari said: 'The continued doctor-centric approach to general practice is not working and an opportunity could be missed by nurses to change how general practice works for the better.' She added that continuing to focus on doctors and nurses as separate workforces perpetuated perceptions of general practice as the doctor's domain. She cited this as a barrier to adopting integrated models of general practice, using the skills of various health professionals.
'We know over a third of the general practice workload is attributable to practice nurses. In the current model the GPs time is consumed with inappropriate tasks. If a skill-mix model was adopted, in which tasks were spread between doctors and nurses best suited to perform them, it would free up doctors' time so that they could do what they are qualified to do.'
She pointed to NHS England's Five Year Forward View, which set out the need for practice nurses to work in partnership in integrated care models, and the Transforming Nursing for Community and Primary Care (TNCPC) strategy. This, she said, would ensure that nurses use their 'unique skills' to deliver person-centred, preventive integrated care.
Ms Lupari acknowledged that significant work was being done by HEE to support the delivery of community and primary care nursing services to meet current and future health needs. 'Other work is ongoing to set out clear education and career pathways for district and practice nurses, by creating a framework in England including education; commissioning service specifications; a career framework supported by educational standards; and the CPD requirements of the current workforce.'
'Nurses have an opportunity to change how general practice works in the future. Within the TNCPC we have chief nursing officer Jane Cummings leading on the development of models of commissioning to deliver integrated care and support for patients, their families and caregivers. This is a fabulous opportunity for nurses to define their commissioning needs, and optimise their role in a new integrated primary care system.'

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Until paractice managers realise they do not make clinical decisions affecting nurses this will never happen. The managers can attend meetings in work time but nurses cannot. Practice nurses ,collectively, are a very powerful force. Nowhere else in the NHS do non clinical staff dictate what nurses can do. Leaders are not allowed to lead and nurse managers are few and far between even though many have trained as managers. Practice managers change appointment times without the nurse consent etc. nurses are just being used in general practice as 'work horses' to achieve QOF points
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