Leading change

The Clinical Quality lead nurse for primary care, working for North and South Norfolk Clinical Commissioning group (CCG), developed bespoke virtual learning hubs to ensure equity of access and engagement for primary care nursing team development. The programme supported local Advance Nurse Practitioners (ANPs) to deliver a national course through work based learning, supporting the delivery of consistent in-house nationally accredited training.

Where to look

The Clinical Quality lead nurse at North and South Norfolk identified unwarranted variation in the consistency of training and education available to primary care nurses across the region which meant a variable service offer to patients within the locality.  Health Education England (HEE) identified that high-quality education should be available to all staff working in primary care to give them access to continuing professional development, enable them to develop advanced skills, and provide them with the leadership and management skills to run new primary care organisations such as federations of GP practices (Health Education England, 2015).

In order to ensure that competent, informed Advanced Nurse Practitioners (ANPs) and General Practice Nurses (GPN’s) were equally as accessible across Norfolk with consistent national training and standards, the Clinical Quality lead nurse for primary care recognised the opportunity to develop education programmes locally, including how these were delivered.

What to change

As the nursing profession continues to develop and change: to enable it to be responsive to society’s changing health care needs there is a need to utilise new models, skills and develop new knowledge bases. Advanced practice roles continue to emerge more commonly. The RCN identifies that these roles are characterised by the following principles: autonomous practice, critical thinking, high level of decision-making and problem solving, values-based care and improving practice (Royal College of Nursing, 2018). These characteristics are underpinned by the “Four pillars” in the RCN Credentialing for Advanced Level Nurse Practice; the four pillars defined as: Management Leadership, Education, Clinical and Research (Royal College of Nursing, 2018).

The NHS England General Practice Nursing 10 point action plan launched in 2017, highlights the need to recognise and develop General Practice Nursing roles and was designed to provide a highly-skilled GPN workforce, including  raising the profile of general practice and improving access to training.

Using this body of resources the Clinical Quality Lead identified that the development of a plan, created in partnership with ANPs, GPNs and clinical commissioners would give equity of access and consistency of training and development against national training standards within Advanced Nurse Practitioners (ANP) and General Practice Nursing (GPN).

In collaboration with a multidisciplinary team the lead nurse sought to:

• Adapt the Capital Nurse Preceptorship framework and tailored this for Primary care in the general practice setting
• Increase awareness of prevention work, health promotion and self-care management by making each contact with the public count.
• Develop a locally accredited career trajectory within primary care for Bands 5-8, supporting newly qualified nurses or professionals from secondary care selecting primary care in Norfolk as a first choice career destination
• Creating a bespoke preceptorship programme is an enabler to retain nurses within this field of health care
• Utilising blended learning through remote training, e-learning and Skype supporting a work-based learning platform with a flexible approach for practice teams

How to change

The Clinical Quality lead nurse collaborated with Commissioners, Advanced Nurse Practitioners, business managers, social care colleagues and the local GP Federation to develop a bespoke training offer. The aim was to create a local delivery-led health care development programme aligned to a national accredited programme has been provided to enable the bespoke “Norfolk offer”.

Adding value

Better outcomes – The impact upon patients will not be fully evaluated until Cohort two has been completed, which won’t be for some time, however North and South Norfolk CCG anticipate that as staff skills are developed, compliance with standards will increase. The key metrics of the programme are to educate and empower General Practice staff to;

• Reduce avoidable hospital admissions
• Reduce unnecessary GP Call outs
• Reduce workforce attrition rates

Better experience – Current evaluation of the programme has been focused on the effectiveness of the education programme provided across Norfolk. The initial cohort have provided very positive feedback:

• “Being able to discuss practice with other members of the group and share experiences was a highlight”
• “I will return to my practice with more knowledge and information for my patients”
• “I can take what I’ve learnt to practice and discuss things with the patients and know where to look for more info and advice”

Better use of resources – Working collaboratively across the Sustainability and Transformation Partnership (STP) footprint with partner CCGs the team has created a virtual support network of mentors, preceptors and ANP tutors to share venue costs and reduce impact upon one practice through collective facilitation and hosting.

Challenges and lessons learnt for implementation

Through the initiative, the team have learned a number of lessons:

• In order to realise your vison, it is important to identify appropriate funding streams early.
• Co-production and sustained engagement is imperative to ensure credibility with health and social care partners.
• Sufficient time and resources needs to be given to programmes such as these to ensure they are successful.
• Memorandums of Understanding (MoU) are extremely helpful in mapping out roles and responsibilities as well as ensuring the programme complies with best practice and has effective governance.
• Learn from National Initiatives and lead them locally in pursuit of quality improvement.
• Never underestimate the resilience of nursing staff, to respect the level of skills and knowledge that my colleagues have, and to work as a team acknowledging that Norfolk has a wealth of expertise.

The programme is now focused upon expanding for the next cohort intake.

For more information contact

Marie McDermott Clinical, Quality and Patient Safety Manager
North and South Norfolk Clinical Commissioning group
Marie.McDermott2@nhs.net