Leading change

The Nurse for Primary Care Workforce Tutor at Eastbourne, Hailsham & Seaford (EHS) and Hastings & Rother (H&R) Clinical Commissioning Groups (CCGs) in Sussex led on the development of General Practice (GP) placements for pre-registered nurses. This project enabled student nurses to experience General Practice Nursing (GPN) and aims to support succession planning for the future of general practice nursing.

Where to look

NHS England (2017) identified some key actions for General Practice Nursing which included:

• Increase uptake and promote nursing in general practice – by raising the profile of nursing in general practice through the ‘Image of Nursing’ programme, offering clinical placements for undergraduates and supporting additional routes into general practice nursing;
• Support for existing GPNs – all nurses new to general practice will have access to an induction programme, training and mentoring and an expansion in leadership and career opportunities;
• Encouraging GPNs to return to practice – the national return to practice programme now includes GPNs. Regional GPN Boards will provide a platform to share best practice.

The nurse for Primary Care Workforce Tutor (PCWT) and the Tutor Lead for Advancing Nurse Practice reviewed the GP workforce data across Kent, Surrey and Sussex as collected by Health Education England. They identified an increased anticipated reduction of qualified GPNs across the region due to projected retirement in the next 2 to 5 years. This was in line with national concerns, but appeared heightened, which placed GPN capacity and capability within East Sussex at risk. There was no clear strategy in place to address this.

What to change

The nurses recognised this as an opportunity to strength collaboration and communication with the local university, to increase the opportunities for pre-registration nursing students to experience General Practice placements. This could raise the profile of nursing in General Practice as a career option and showcase the opportunities available. Alongside this, the nurses increased the professional development support for the non-medical workforce, advancing skills and academic progression as well as actively growing nurse leaders. The PCWT role within EHS and H&R CCGs identified seven existing GPN mentors ready to support students but placements needed to be on offer.

How to change

Utilising the evidence and recent guidance, the following actions were addressed:

• To increase the number of nurse mentors;
• To develop the current local GPNs in line with the national career framework;
• To support GP providers to develop and enhance their educational environments;
• To support GPNs with protected time to offer structured, quality placement experiences and to audit this practice;
• To provide a programme of education that showcases the depth and breadth of working as a GPN and to encourage new nurses to consider general practice as a first career destination;
• To support GP providers in understanding the aim of the programme and to continue to support the workforce of the future.

Collaboration and co-production with the university supported the vision of what an excellent placement should look like and the skills which could be achieved in the GP provider settings. The PCWT and the Tutor Lead for Advancing Nurse Practice have formed close working relations with the university colleagues, to support ongoing development of the programme.

The changes made to implement the programme included:

• Providing students with opportunity to observe all aspects of the system and facilitating bespoke opportunities;
• Developing an induction pack which was adopted by GP providers. This included the expectations of the practice, the student and the skills the student training is delivering, either supervised or unsupervised. This document continues to develop, especially as the team are moving towards hosting multi-disciplinary placements;
• Developing a preceptorship programme to support newly qualified nurses awaiting their PIN;
• Creating a workforce development conference locally.

The programme aims to bring the right education, training and development to enhance skills, knowledge and understanding to the future nursing and wider workforce.

Adding value

Better outcomes – A large proportion of local GP providers have started to host student nurses and the nurse mentors have driven the success and enthusiasm of the change. The programme now has 85 nurse mentors and 10 sign-off mentors. The programme is currently supporting the development of 4 nurse educators through leadership modules. As well as demonstrable increases in student and mentor numbers, a notable sign of success is that six newly qualified nurses have taken on nursing roles in the local GP provider in the first 2 years.

Better experience – The programme and the university have sought feedback from GPNs and GP providers to ensure the programme remains successful. Further evaluation into the impact on patients will be considered. Based on student and mentor evaluation, the patients like to see student activity and enjoy the positive interaction at their appointments. Student feedback includes:

“This placement was truly amazing. My confidence as an independent nurse grew stronger. I felt like a member of the team within a week and I gained ability to practice autonomously and learned to provide clear, written communication and accurate documentation. I was supported all of the time to extend knowledge, skills and practice. I learned to plan care for the patients. All the staff in the practice was very professional and supportive and I cannot praise them enough”.

Better use of resources – The GPN environment locally has transformed practice so that it is increasingly focused on education and continued professional development. Shared training and learning across the practices has improved for all staff and students. Although no clear correlation can be drawn, it is hoped that the programme will continue to enhance student development regarding exposure to general practice nursing which will support local practices to prepare for the future which is increasingly focused on primary care and care closer to home.

Challenges and lessons learnt for implementation

Nurse mentors are critical to the process of assessing student nurses’ practice skills.

It is important to work with practices to increase engagement and to provide support in receiving students to continue the success of the programme.

The programme aims to bring groups of practices together, with an identified educational lead within each group. This will be the designated responsible person for the hub-and-spoke activity of learners.

For more information contact

Dee Kellett
Primary Care Workforce Tutor
NHS Hastings and Rother CCG, NHS Eastbourne, Hailsham and Seaford CCG
dkellett@nhs.net