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When will change result from all the practice nursing data?

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The problems have been identified, but national so The problems have been identified, but national solutions remain elusive

As this year's RCN Congress draws closer, one of the motions passed last year is vital for practice nurses.

In an almost unanimous vote, RCN members passed a resolution for Council to lobby commissioners and regulators to support the development of a recognised national qualification and career pathway for practice nursing.

Speakers in support of the resolution felt this had long been something that the profession needed, as many nurses were unclear about how to enter practice nursing or were put off by the lack of a clear career pathway.

The RCN's interim report on last year's Congress1 states that there are a number of steps being taken to achieve this including working groups and meetings with other organisations.

It is encouraging that RCN members recognised that there is no national description of the practice nursing role. But over the past few years, there has been a lot of data collection, surveys and groups (Box 1) set up to enhance the practice nursing profession. They continue to identify the same issues such as the ageing population, the lack of training and a clear career pathway for practice nurses yet little progress has been made. In the last issue of IN, the results of an RCGP survey that was conducted last year were communicated.2 The article referenced two previous surveys that were carried out to collect national data on practice nursing.

Box 1: What has been done so far?
  • Working in partnership snapshot survey 2008
  • RCN practice nurses employment survey 2009
  • RCGP general practice nursing survey 2014
  • QNI practice nursing survey 2015
A number of groups have also been set up within various organisations. As well NHS Alliance's GPN network, and HEE's working group, there is the RCN's practice nursing forum the RCGP's focus group Practice nurses are represented in NHS England, the CQC and Public Health England by dedicated practice nurse leads.

Heather Henry, co-chair of the NHS Alliance and founder of the NHS Alliance general practice nursing network, says that practice nurses keep being surveyed but there is never any action taken as a result. 'We keep repeating the same problems with no outcomes. It is not ethical to work nurses into a lather and then nothing happens,' she says.

The RCN interim report states that there is currently a working group within Health Education England (HEE) developing a career pathway for practice nurses. This was also introduced in Lord Willis' report on future nursing education, the Shape of Caring Review, released in March 2015. The group was brought together by HEE as part of its 'transforming primary and community care' work streams.

The aim of the group is believed to be to design a career framework, competencies, and education commissioning specifications. The Shape of Caring Review put forward the idea that practice and community nursing could become the fifth field of nursing.3 Lord Willis backed a better pathway for practice nursing. He told IN that general practice nursing was a 'rich training ground for students and that's an absolutely essential area if we are going to develop more community and primary based healthcare'.

Jenny Aston, chair of the practice nurses' forum at the RCGP, says that developments are being made but they are happening very slowly.

'The issue is that there are a lot of people trying to do the same thing, so things aren't happening as quickly as they could be.

'What we need is one group of people with a clear idea of what practice nursing needs and to have the resources and funding to be able to achieve that. While we do have some very good examples locally, the lack of good nursing leadership means that national programmes are not happening,' she adds.

And elsewhere?
Across the UK, there appears to be slightly more progress on providing more standardised education for practice nurses.

NHS Education for Scotland has a practice nurse development programme aimed at preparing new practice nurses for a career in general practice. The programme has been running for a few years and is funded by NHS Education for Scotland, the Scottish equivalent of HEE.

Susan Kennedy, programme co-ordinator of the GPN programme, says that it has been expanding since it started in September 2012. Since its inception the number of delegates has increased and the programme has evolved in line with student evaluations.

'Our programme reflects the thinking that practice nurses should have a generic learning programme. Yes it is important to specialise but [practice nurses] do need that sound baseline.'

'Although we are unable to run the exact programme in England we are willing to share some of the learning with HEE to replicate a similar programme,' she says.

There is also a network set up to connect practice nurses across Scotland so that they can discuss education. The network looks at key areas that will affect nurses such as revalidation, CPD and linking practice nurses locally.

Scotland also has a competency framework for practice nurses, which HEE's framework will echo.

In Wales a fund was dedicated in 2014 to training primary care staff, which included training nurses in advanced practice such as prescribing and introducing more nurse-led phlebotomy. £3.5 million will be invested within the next year and a further £10m will be invested in Welsh primary care as a whole.

A Welsh government spokesperson told IN that a national primary care workforce development plan is in progress to support the funding allocations.

Jeremy Hunt has promised that he will prioritise out-of-hospital care as the reinstated health secretary. It will be interesting to see if that encompasses primary and community nurses. As Marina Lupari, the professional officer for primary and community nursing, told IN when she first came into post: 'The UK has a problem in that as a health service we don't acknowledge primary care. We actually do it very well, even if we know there is so much more we could be doing.' Data has been collected, groups formed, reports written and recommendations made. This is all useful and necessary, but practice nurses need it to translate into actions that create change for all.


1.RCN Congress Interim Report. RCN Congress. https://www.rcn.org.uk/__data/assets/pdf_file/0011.... Accessed May 2015.

2. J Aston. A picture of practice nursing today. 2015. p39. Independent Nurse. http://www.independentnurse.co.uk/professional-art...
practice-nursing-today/82361

3. Bhardwa S. Community - the fifth field? 2015. Independent Nurse. p12. http://www.independentnurse.co.uk/news/community-the-fifth-field

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