Community and primary care workforce development – Guest blog from the QNI

7 October 2016

We are invite members and guests to share their views and experiences of community and primary care workforce development. Calls to increase student exposure to primary care and create post-registration courses for professionals working in this area pose challenges for all involved, including universities.

We invite members to share their ideas in the comments section below.

We start here with a guest blog from Crystal Oldman, Chief Executive of the Queen’s Nursing Institute.

Crystal Oldman, Chief Executive of the Queen’s Nursing Institute

There can be no doubt that community and primary care have become the focus for workforce development in England.

The Five Year Forward View published in 2014 by NHS England emphasized the need to deliver more care in people’s homes and communities. In 2016, the General Practice Forward View provided confirmation that the primary care workforce is multi-disciplinary, with a critical contribution from General Practice Nurses (GPNs) who form the next largest professional group to General Practitioners in this context of care.

The direction of travel is clear and there is a pressing need for the policy initiative to be supported by greater investment in the community nursing, primary care and allied health professional workforce.

The Queen’s Nursing Institute (QNI) has been running a campaign named ‘Right Nurse, Right Skills’ for the last 4 years and we have based the campaign on sound evidence of the impact on patients of significant under investment in community nursing services.

The QNI published a report in January 2016 based on responses from over 3400 GPNs: “General Practice Nursing in the 21st Century: a time of opportunity”: There was evidence that 34% of GPNs are due to retire by 2020; that 43% felt their team did not have the right skills to meet the needs of the population served and almost half had no support from their employers for their professional development. There was however, a great sense of satisfaction and reward in working as an autonomous practitioner to serve and develop long-term relationships with their local community.

From this evidence, it is clear that there is still much work to be done in raising the profile of GPNs, developing and retaining the existing GPN workforce and attracting the next generation of nurses to discover the joy and reward of working in primary care.

The HEE career framework for General Practice Nursing published in 2015 has been a catalyst for the dialogue around GPN development needs and many LETBs have supported the development of GPN foundation programmes for nurses new to General Practice, with considerable success. The QNI has also published a free online learning resource: ‘Transition to General Practice Nursing’ for those who are new to General Practice that can be used by the nurse and mentor to support the development of GPN skills.

The support of GPNs to develop further as Specialist Practitioners and Nurse Practitioners, including becoming Independent Prescribers, will be essential to the delivery of the GP Forward View and most importantly, will create a service that meets the needs of the local communities. The challenge of course will be the funding of such programmes, when the HEE Continuing Professional Development (CPD) budget has been cut by almost half and is likely to diminish even further in the coming years.

In recognition of the critical role of the GPN with the NMC recordable specialist practitioner qualification, the QNI and QNI Scotland (QNIS) are currently developing new voluntary standards for education and practice to enhance the existing NMC standards for specialist practice in General Practice Nursing. These follow the successful publication in 2015 of the QNI/QNIS voluntary standards for District Nurse Education and Practice, to which most District Nursing programmes are now mapped:

The restructuring of local primary care practices into GP federations may give nurses further opportunity to develop a career in primary care. The development of primary care and community pathways in pre-registration programmes in some HEIs is providing fabulous opportunities for those who have identified this as their first destination on qualifying.

Whilst 90% of all clinical contacts in the NHS occur in the community and primary care, General Practice Nursing remains mostly invisible to student nurses as a viable career option. The QNI was recently funded by HEE to showcase examples of excellent practice in supporting student nurses to undertake placements in primary care – and to examine the barriers and enablers to this learning.

It will be no surprise that the placement tariff can be a barrier and that student indemnity remains a significant issue for many practices. The enablers include a commitment by the HEI to prepare students appropriately for primary care placements and by the CEPNs and CCGs to provide mentorship development and supportive learning environments. However the lack of nurse tutors with a clinical background in community and primary care was noted as an area requiring further development for some HEIs.

Medical students are told on day one of their 5 year programme that 50% of the cohort will become General Practitioners. No such clear career pathway exists for nurses, but it is an opportunity that we should consider making more visible.

The QNI is currently working on articulating a vision for a career in the community and primary care that could be shared with all cohorts of student nurses, inspiring them to seek a career in the community and to recognize the fabulous opportunities of autonomous working as part of a multidisciplinary team serving a local community. We will be releasing this as part of our 130th anniversary year in 2017.

We look forward to supporting our colleagues in Higher Education with this vision and other appropriate resources to enhance pre-registration and CPD programmes.

We would be delighted to hear about other ways that you consider the QNI may be able to help:



2 responses to “Community and primary care workforce development – Guest blog from the QNI”

  1. David Wylie says:

    ‘There was however, a great sense of satisfaction and reward in working as an autonomous practitioner to serve and develop long-term relationships with their local community.’
    The phrase ‘autonomous practitioner’ intrigues and concerns in about equal measure. In today’s governance structures it really is a misnomer at best and, at worst, a proxy phrase for not being open to challenge, accountability or change. On the one hand the. Orion of being part of a Multidisciplinary Team is embraced, yet on the other the bizarre notion of individual ‘autonomy’ continues to appear in the culture. The word autonomy comes from the Greek roots auto meaning “self” and nomos meaning “custom” or “law.” Dictionary definitions uniformly indicate that this reflects the political sense of the word — a group’s right to self-government or self-rule. When a person seeks autonomy, he or she would like to be able to make decisions independently from authority. Please help me understand the ‘autonomous practitioner’ in a properly governed health care system?

  2. The England Centre for Practice Development is currently undertaking an evidence review of safe staffing for the NHSI for adult community nursing services and we would be delighted to share these findings with the Council of Deans for Health in the coming weeks. The report will be submitted at the end of October

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