David Purdue
Afternoon, I’m David Purdue, regional chief nurse for North East and Yorkshire. So, in this special episode to mark 12 May International Nurses Day, we’re here to talk about the role of nursing in primary care and how it’s evolving, and that’s due to the all the additional roles reimbursement scheme last year and the aims of the 10-year plan and the neighbourhood health framework.
Nurses are key members of the multidisciplinary team with hands-on clinical knowledge combined with in-depth knowledge of the community in which they work. So our roles continue to evolve and are even more essential.
So how are primary care nurses across our region improving routine care while supporting long-term conditions and providing better alternatives to hospital treatment? So joining me to discuss this today are Anna Young, who’s the Advanced Practice Training Programme Director for Primary Care. She also works as primary care advanced practice nurse and prescribed development lead in South Yorkshire.
Becky Weston, the community matron for Bradford District and Craven, Joanna Vintis, the lead nurse and head of workforce development for Newcastle GP Services, and our out of region guest panelist is Stef Costa, the Regional Primary Care Nursing Workforce Educator Lead for NHS England, East of England.
So I began my nursing career back in 1987 in Nottingham. Before my current role as the regional chief nurse for NHS England for North East and Yorkshire, I spent most of my career in secondary care, so I was the chief nurse and deputy chief executive at Doncaster and Bassetlaw Teaching Hospital and then I was the Chief Nurse and Deputy Chief Executive of North East and North Cumbria Integrated Care Trust Board. So during that time, I really got to understand primary care nursing far more than I ever did as a provider. But actually, the ICB had a pivotal role in ensuring community health and primary care. So I think it’s really important that we look to how we outline the role of the primary care nurse is rapidly changing – to change across primary care in pharmacy, GP practice, PCN roles, neighbourhoods. So I’m going to start by asking Joanna – tell me more about how the workforce is developing in the North East and within Newcastle GP services.
Joanna Vintis
Thanks, David. I’ve only ever worked in general practice. So I never worked as a staff nurse in a hospital. I qualified in 2010 and went straight into a GP surgery. So when I think about the last 15 years in general practice, it’s my own development as well. And when I first started, it was very much I was doing bloods and blood pressures and information gathering – that’s what I felt my role was when I first started. Now, I can’t actually quite get my head around what my role is.
I mean, the title of workforce development doesn’t mean much outside of the NHS, really. But what I think it means is that we’re looking at practice nurses and what our skill set is and expanding that outside of a GP practice. So we have nurses and what NGPS do as a GP federation is – we are the voice of general practice within a much larger system and we’re putting nurses at the forefront of that. And I think 15 years ago, if someone had told me that was what I was going to be doing with my nursing career, I would have absolutely thought they were just going wild. So that for me is really important about what we’re doing.
It’s really exciting, but it’s also quite intimidating when you look at the 10-year plan and there’s a little bit of frustration from general practice nursing in a way – this is what we’ve always done. This is what practice nurses have always done amazingly well. And now we’re just starting to get the recognition of it and care is moving back towards communities and neighbourhoods. And that is just incredibly exciting. So long, waffly answer. I do also want to highlight, I was just born in 1986. I’m just dropping that in(!).
David Purdue
Thank you for that, Joanna. I remember that comment. So it would be really useful, I suppose, from the panel in terms of how that role of primary care nurse has developed in recent times from your perspective. So I think, Joanna, you’ve put some of that in. I’m really interested to hear from our other panelists in terms of how you think the roles developed. Anna-
Anna Young
Hi, David. Yeah, thank you. I wasn’t born in 1986. I was a bit before then, but not quite. But yeah, it’s scary thinking that people have nursed for while we were children. But I think it’s really interesting because actually general practice nursing wasn’t formally introduced into primary care until the 90s. But since then, nurses have been the bedrock of patient population health, doing women’s health, chronic disease management, vaccinations, wound care, birth to grave health care. In fact, primary care is the only nursing specialty that that provides health care across the whole of the lifespan. And general practice nurses build relationships with patients and their families. We’re proactive in extending our scope for the benefit of the patient. So prescribing, specialist qualifications in respiratory, diabetes, travel health, contraception, and then onwards for some of us into advanced practice, but still applying a nursing lens of patient education and health promotion. So it’s the whole person and the whole lifespan of healthcare.
Patient interactions these days are increasingly complex and well-trained, experienced and embedded-in practice nurses are worth their weight in gold. And I think with new roles coming in, they’re really, really welcome and because there’s more than enough work for all of us, that actually each profession brings its own unique perspective and interaction to the patient journey.
I think as nurses we need to remember and recognise our roles as the lynchpin of patient health and wellbeing and our unique training and perspective of kind of primary care and general practice in managing complexity, multi-morbidity and building networks of relationships. We need to retain our nurses as our experienced nurses to mentor those coming through – because actually we need nurses more than ever in primary care for the future, as Joanna says, for the 10-year plan to actually happen.
David Purdue
Thanks, Anna. That’s great. And obviously you do see the whole life cycle. And if we look at the 10 -year plan, how do you think the practice nurse role is within the prevention agenda? I’d be really interested in terms of – we talk about 3 shifts, don’t we, and we’ve talked about it for years and years and we’re hearing a lot around neighbourhood health and people understand that – but what do you think your role is in that preventative space? Anna-
Anna Young
It’s who we are – the whole of primary care nursing, the whole of general practice nursing is preventative. It’s our bread and butter. It’s what we’re trained to do. Even – I work in an advanced practice role now, and you could argue that a lot of that is reactive, because a lot of it is kind of on the day. But even then, it’s applying that preventative lens. It’s using our specialist skills within managing long term asthma, diabetes, chronic respiratory conditions. It’s remembering and reminding patients about the importance of vaccination. We don’t work in a vacuum. We don’t work in isolation to the whole of the patient and the whole of the family and the whole of society in which that patient lives. You know, the communities, we know these communities really, really well because we’ve worked there forever. We might be vaccinating kids of people that we vaccinated as they were children. You know, there’s a real longevity about nurses in primary care. But I know Joanna has got loads to say on this. I’ll pass over to her.
Joanna Vintis
The thing with that is – at NGPS, we’re looking a lot about community engagement and we have a wonderful community outreach bus called Monty – and nurses go out into the community to deliver health checks. And one of the biggest barriers we’ve got when we start looking at prevention rather than treatment is how do we engage with communities in the way that they want to be engaged with. We can’t tell them how to engage with us as a service. They need to tell us how we should engage with them. So actually going out and doing that and having nurses just visible out there is phenomenal and it’s a great thing to do with a nursing career and I think it’s something that’s not recognised enough.
And what general practice is, and it totally echoing what Anna said, we’re this anchor point in people’s healthcare journeys and that trust is built up, not only just over lifetimes, but over generations, you will get this ripple effect where if we’ve gone and engaged with the community in a safe, and really welcoming way, they’re more likely to engage with health information because we are bombarded with it through social media. And when you look at the 10-year plan, let’s go digital, let’s take everything digital. How much information is out there in the digital world? And it’s really difficult to understand. So actually, sometimes people just want that human element. And I think that’s where – nurses, that’s our superpower! And I always say, I am rubbish at medical terminology. If someone asks me to pronounce a drug, I’m rubbish. My excuse is, oh, for 15 years, I’ve been trying to say it in a way that patients understand. It’s not that I can’t say it, but it’s real. And it’s kind of, if we’re giving information to patients that they can’t understand and we’re saying this is how you’re going to access the best building. It’s got the best healthcare professionals in it, but you have to go through a Fort Knox of an app to get into it, to get an appointment. Actually engage with our social prescribing teams who can help you get onto the app and understand how you use it so that you then trust the service and you come in and see us and we can do your health check. That’s cool.
David Purdue
Excellent. Stef –
Stef Costa
Thank you, David, and it’s a real pleasure to be part of this group. It’s such a wealth of knowledge and information. When I reflect on the role of the primary care nurse and how it has developed in recent times, what stands out for me is not just how much the role is expanded, but particularly how it has become far more innovative, integrated and future facing. I mean, we’ve moved well beyond the traditional task-based care into roles that are clinically autonomous, they are system aware and they are central to the multidisciplinary teams which in their own right, they change significantly as well. Primary care nurses today, they are not just delivering care, but they are shaping the services, they are influencing pathways and they are leading transformation within their communities and the patients that they serve. In the East of England and from my experience, one example that really captures this change in the nursing role is the ‘Inspire Project’- a project that has been developed as a response to some of the longstanding workforce challenges in general practice that included, for example, addressing the limited placement capacity that we experience in general practice, the workforce shortages and the confidence levels within the nursing workforce as well. And what’s particularly innovative about the Inspire Project, it’s how it brings together the education, the workforce development and the digital technology together.
And that is driven by the nurses themselves, for nurses, and it has developed into other professional groups as well. But this particular project that is led by nurses, utilises a blended approach which combines the virtual learning environment with real world general practice placements, which allows students to build skills, confidence and experience in a way that simply wasn’t possible before. So that impact has been significant and we’ve seen growth in educator capacity, expansion of placement opportunities and a real positive student feedback with so many now actively considering general practice as a career destination as a result. So what we’re seeing is nurses increasingly operating at those junction points where workforce meets education, meets digital innovation, and they all come together. And that’s where some of the most meaningful transformation is also happening.
David Purdue
Thanks, Stef. It’s really great with these podcasts that we can share what’s happening everywhere and share the really good practice. So can I just ask then, how are you utilising your skills as a nurse in current projects in your region as they’re making a real difference to primary care teams and our patients. So can I come to you, Becky?
Becky Weston
Hi, David. Yeah, so I’ve been qualified 30 years as a nurse and worked for two years in my current area. So absolutely knowing your community and knowing generations is very key. Obviously, I see people a lot more in their own homes and I get a real feel for what’s going on in the community.
I think the biggest thing that I’ve recently been involved in is the National Neighbourhood Health Implementation Programme. So I’m lucky as a nurse to be leading that within our primary care network. My team manage people that are generally elderly, frail, chronic long-term conditions, complex health and social care needs and what we’ve been able to do for the programme is break down barriers and work very, very closely with lots of organisations and services. So we’ve been really successful. Now we have a weekly MDT so we can discuss our most complex patients with social care therapy services. We’ve got direct links now with elderly care consultants. So if we’ve got really specialist needs, we can seek their advice and support in the view of stopping, reducing hospital admissions for some of those patients. I’m so pleased to be a nurse and given this opportunity to really, you know, break down the
really complex questions – why have we worked this way for so long and what can we do differently? This is just about trying to work smarter and more effectively.to enhance the care to patients that we give within their own homes and support carers and families. I work in a really deprived area, so, you know, it’s key that we get things right and make sure people can live happy, healthy lives. I feel in such a privileged, lucky position and, you know, it’s about doing the best for what we can for our patients out there. And just to be recognised as a nurse that we can lead. And I think what’s been really successful for us is that it’s, you know, it’s a bottom up approach. So it was on the, you know, grassroots level who are seeing these patients and seeing the challenges we’ve been able to drive the direction of travel for this programme. So it’s been absolutely amazing. And the response from people has been great, from services, hospital care consultants – I just said these are all our patients and we all need to work together to enhance their care.
David Purdue
That’s great stuff, Becky. So, Joanna.
Joanna Vintis
I think I would just echo so much of that. It’s that we always say it’s a privilege to be in our job in general practice. I think we’re in such a lovely position to see patients when they’re well, but also to support them when they’re not well and kind of bridge that gap. From my perspective at NGPS, we have some really exciting projects going on and I always want to big up our research team, which is led by an amazing nurse called Hazel. And it’s one of the very few nurse-led research teams in primary care, we think anywhere in the country. And what they’re trying to do is bring research out into communities that need it. You know, medical research doesn’t often encompass our whole community. It’s very specific. So they’re looking at really innovative studies about children’s health, black and ethnic minorities, trying to get those people involved in research in a different way.
And again, it’s bringing it out to them. So it’s moving away from ‘we’re the NHS, you come to us’, no, we’re going to do it differently. And it’s nurses that are leading that charge. And I think for me, being an advocate for our patients, and I loved that when I had my clinical role, now I’m non-clinical, I feel like I’m doing the same thing for our student nurses.
And I want our student nurses to see that careers in nursing don’t have to be at the bedside. There’s so much more scope that you can do as a nurse and you can go on to some really exciting projects. And student nurses will always be my love and my passion. And when I came to NGPS, it was specifically just to look at trying to get more students into general practice. But I said to them, I can’t ask any of my colleagues to take a student if they don’t feel supported and they don’t feel like they’ve got development themselves. So that’s why at NGPS we kind of made this weird hybrid role of training and development, which is so fascinating when you hear Stef, because this is happening all over the country. We’re saying that nurses have a key role in the development of other professions as well, not just on nursing. So it’s that development side of it will always be my passion and will always be my thing. We’re running a really exciting project with Northumbria University to try and guarantee that every first year student will get an experience in general practice in their first year, so that right at the beginning of the training, they are seeing that general practice is where all the exciting stuff happens. Not that I’m saying it doesn’t happen in hospitals, I’m sure exciting stuff happens there, but the real good health care, all the health prevention that we want happens in general practice. So come on, students, get in on the ground floor! That’s the plan.
David Purdue
There’s some really good work with some of the HEIs around having that real clear focus on community and primary care. So, Teesside University are really keen, Joanna.
Joanna Vintis
It’s an amazing project and it attracts different people because I think so many people now look at nursing as a career and don’t see themselves in it because they don’t see themselves in a hospital setting. But actually look at the 10-year plan. Care is moving away from that. So let’s move our student education away from that as well. Let’s get it thinking differently.
David Purdue
Absolutely. Great stuff. Anna –
Anna Young
Joanna, you’ve just fed perfectly into what I wanted to say because my passion is the four pillars of nursing and you’ve just kind of teed me up really well about that because when I think about using my skills and especially now as a mid-to-later-career nurse, the fact that, you know, we’ve got clinical is a major part of it, but actually we’ve got research, we’ve got leadership and we’ve got education, which are really, really important parts too. And when I think about kind of using my skill, it’s about kind of developing legacy at this point. And one of the things I did when I did my masters in advancing practice was to look at the workforce in South Yorkshire in primary care.and recognised that we didn’t have a support and development model for non-medical prescribers in primary care. So I used my year of kind of research to look at what does gold standard look like and I then spent the last six, seven years implementing that in practice, which is great, that’s really helped general practice, but actually what it’s now doing when you talked about how as nurses we can impact on the other roles that are in primary care. So we’ve got the community pharmacists that are hopefully all be going to be using prescribing within community pharmacy. So I was able to take my role within advanced practice and my understanding of what supervision looks like for new skills and kind of how to support people as they walk into new skills and new roles. And also all the research I did around kind of prescribing to develop a supervision model for the community pharmacists so that they were supported as they stepped into a new role. Because, you know, from walking through it myself, I know that you can’t just take on a new title and a new role without that kind of support behind you. We did that as joint work between community pharmacy and the integrated care board and the workforce and training hub and we’re going to be going to Birmingham to the community nursing and community pharmacy conference and talking about it because actually it’s great the work we’ve done. It’s great the collaborative work and it’s great to be able to bring that understanding of nursing and of leadership and of education and of research into the wider neighbourhood. So not just general practice, but the wider primary care. So we’re talking about more than just the kind of the surgery appointments, but actually what does it look like when it’s wider. So yeah, definitely.
David Purdue
Great stuff. Thank you, Stef.
Stef Costa
Thank you. So amazing. It’s just each time I speak with nurses, I get more and more in love with the nursing profession, if that’s ever possible. But anyway, from my perspective in the East of England, one of the most exciting aspects of the role is that I’m supporting system wide initiatives, as I mentioned before, but that genuinely shifts the dial for both patients and the workforce. And a big part of that is around the education and pipeline development, working with the HEIs – with the universities to embed primary care in their undergrad curricula, very much like what Joanna was mentioning. So that students see general practice as a first destination career, not an afterthought. So that’s about long-term sustainability and creating a workforce that is confident, capable and ready to work in these evolving models of care. But one area that I’m particularly passionate about, and which I think is quite pioneering, is the work that we’re doing around geo-mapping primary care nursing across the region, combined with the development of primary care nursing specific metrics. So we designed and implemented these metrics across the systems, and it has been a labour of love for over a year now. And now we moved on to triangulating these metrics with other data sources. And what that gives us for the first time is a comprehensive and evidence-based picture of primary care nursing across four key dimensions, across educators, students, placements and workforce. And that level of insight is incredibly powerful. It allows us to move from beyond the assumptions and clearly identify pressure points, that so far we weren’t aware or could perhaps have an idea of it, to then now have an understanding of the variation and pinpoint the gaps, particularly in areas of deprivation. So actually enables us a much more targeted and strategic approach, whether that’s expanding placement capacity, or supporting educators or addressing workforce challenges where they are most needed. And crucially, it strengthens evidence-based decision making, both at system and at regional level. What’s even more exciting is how we can translate those insights into neighbourhood working -helping to shape integrated teams that are truly responsive to a local population need. And that’s where nursing really comes into its own, because when you combine data, clinical expertise and deep community understanding, nurses are uniquely positioned not just to contribute to change, but actually to lead on it. And that’s what I’m trying to work to achieve for the current and future workforce in my region.
David Purdue
Thank you, Stef. That looks like we’ve got some learning to do from East of England (!)
Stef Costa
Happy to collaborate anytime.
David Purdue
So that would be great! So they’re really great examples of innovations that people have put in. And obviously we’ve got more in the region. We’ve got the Gleadless and Healey Medical Centre, which opens 24 hours a day, supporting the local community to access better mental health provision. And that won our regional NHS Excellence Award. We’ve got Gateshead Women’s Health Hub. So, Dame Leslie Regan, who leads Women Health, recently visited and looked at the design to provide joined up care in the community locations for women’s health and care – I think North East North Cumbria is kind of leading the way in terms of women’s health. And then the South Yorkshire ICB is looking at certain group clinic models to address health conditions such as cardiovascular disease – some really great innovations in the patch, all being led by our nurse colleagues.
So the kind of final question, which we’ve covered some of it really, is just how will primary care nursing continue to evolve to respond to the recent publications like the 10-year plan and the neighbourhood health framework. So what do you see are the challenges and what do you see are the opportunities? Joanna.
Joanna Vintis
I think the big challenge is recognising the amount of work that we already do. And I think Stef touched on that brilliantly, that we are often seen as, well, we feel like the underseen workforce, that we’re already delivering so much high-quality care. But it doesn’t get recognised. A quote I will always come back to is somebody once asked me why I was still practicing after 15 years, had I not figured it out yet. And although that’s brilliant, you just think if that’s maybe what people think that as practice nurses, we’re just giving it a go, we’re a little bit of a jack of all trades. We’re not. We’re long-term condition specialists. We’re vaccine superstars. You know, the screening programmes that we do and that I’m part of as a nurse, I am just so proud to be in. So I think the biggest challenge is how do we get the nursing role recognised so that our voice can be louder within the system. The 10-year plan for me, it’s more putting us on the pedestal that we should already be on. You know, the nursing teams that I work with are absolutely amazing and they’re already doing some brilliant neighbourhood working. And one of our nurses, Becky, just, there’s a video of her on our website where she literally, you see her just pick up her bag and go to a local food bank and deliver a clinic from there. Isn’t that the type of nursing that we should be supporting as a region and as a country of going – that’s what I think nurses should be. And I’m so proud to be able to represent them and to be able to shout about what they do. But that is our biggest challenge. And funding, I will always say it, is always going to be a big one. The training that we need to be practice nurses is phenomenally expensive and we do not get access to the same things that some of the other nurses in trust settings get. So we need that desperately – you can’t ask us to be a bigger part of the system but not fund it. I think that’s the big one. So I think the 10-year plan is really a recognition and I think a very nice sort of underpinning of what practice nurses are already doing.
David Purdue
Thank you very much. Anna
Anna Young
I think you’re absolutely right, Joanna. Money is the key because the opportunities are endless and the nurse’s ability to meet the need with creativity, with innovation, with a wealth of experience and knowledge and passion – it’s unending.
One of my ongoing frustrations is the challenge with the fact that we can’t join up work because there isn’t that funding to allow nurses to meet together to have that kind of ‘what’s happening here, what’s happening there, join it up,’ to have leadership structures that enable nurses to be at the table and to have those conversations, to attend things like the primary care collaborative meetings – that kind of work at an ICB level.
And I’m talking about clinical nurses now, I’m not talking about, you know, people who have a non-clinical role perhaps in the training hubs, but we’re talking about clinical nurses that don’t have somebody necessarily that is there to represent them at this level and then the next level up and then the next level up. And it’s a piece of work that we’re kind of looking at the moment about how we can create structures that are equitable to the structures that perhaps nurses have got that are employed by trusts, so that at every level nurses are working strategically and have the ability to influence. Because we know we can influence, we know we’ve got the ideas, we know we’ve got the experience.
Our employers don’t want to prevent us from doing things. So, you know, if the finance came down to allow these things to happen, then I think it would explode exponentially. The financing of the left shift I think is really exciting and that’s what needs to happen.
David Purdue
Thanks, Anna. Becky
Becky Weston
I think we’re in a really exciting, privileged position and particularly in primary care. I sometimes go on the wards now and I think it’s still quite hierarchical in hospitals.
So I do think we are in a good position. There’s a lot of inspiration out there. I agree, we’ve got to beat the drum about our role. And sometimes nurses, you know, people think – they’ve still got that image haven’t they, that we’re a handmaiden and we’re certainly not. And I go in to see people at homes and they’re very much ‘ Oh, I haven’t had a GP visit’ and it’s when I say I’m a nurse. And at first, sometimes you do get some resistance, but actually you come away and they’re like, oh my goodness me, that is absolutely fantastic what you’ve done in that today. You’ve covered absolutely everything.’ And that’s what we do, you know, right through that health and social care spectrum. We’ll ask those questions, which, and people are quite shocked and amazed that we will go that far because it is about breaking down those barriers. So I agree that, you know, we’ve got to have the training, we’ve got to be valued and respected and there’s got to be money in place. But I think we as a workforce can really drive the direction of primary care nursing. And it’s not always a practice nurse as well. We’ve got to think about our district nurse colleagues and any primary care nurses across the whole spectrum, whether they’re working at a GP practice or within community trusts as well. But I do think we can really drive this forward.
David Purdue
Thanks, Becky. Stef.
Stef Costa
Looking ahead, primary care nursing will be central to delivering the ambition set out on the 10 year plan and the neighbourhood health framework. We often talk about the three big shifts and nurses are uniquely positioned to lead across all of them three. We know that. We can see that in the shift from hospital to community. Nurses are already managing increasingly complex care closer to homes, often coordinating across services and acting as the constant with the multidisciplinary teams in the move from treatment to prevention. This has always been the core to nursing, supporting people to stay well, manage long-term conditions and make informed choices about their health.
And in the shift from analogue to digital, in addition to the example I’ve given before, we already seeing growing confidence in using technology to enhance care with initiatives like the Inspire I mentioned before showing how powerful that integration of digital can be. So looking ahead, another important shift, I think, is how we think about nursing within primary care itself.
General practice is general. The clue is in the name. So it’s no longer, I think, the domain of a single type of nursing or nurse. It is becoming a space where all fields of nursing can contribute meaningfully bringing their specialist expertise to support diverse population needs. And this will become even more important as we move forward towards neighbourhood models of care.
We are already beginning to see nurses working more fluidly across traditional boundaries at neighbourhood level alongside other teams. For example, a nurse with child health
background working within general practice can collaborate closely with school nursing colleagues who are employed by local authorities, combining their expertise to deliver more joined up care, holistic care for children and for their families. So that ability to integrate different nursing specialisms within local populations will be critical to deliver truly meaningfully person-centered, proactive models of care. And it’s a shift from thinking about models or roles in isolation to seeing nursing as a connected system-wide capability.
So of course, there will be challenges like workforce capacity, educator availability and access to development of opportunities, But these challenges also present an opportunity, I think, to rethink how we redesign or design and support the workforce of the future. And as neighbourhoods working continues to evolve, nurses, I believe, will play a pivotal role in shaping those models that are integrated, equitable and sustainable. So in order to succeed at neighbourhood care, ensure that general practice nurses are at the centre of it, both at strategic and operational level. That’s my view.
David Purdue
Thanks Stef. Do you want to come back in Anna?
Anna Young
Yeah, thank you. I was going to pick up on two points, actually. One of Becky’s and of Stef’s And I think it’s really important to remember within the kind of primary care neighbourhood model is our independent sector nurses as well in care homes, because actually, they play a massive part in the health prevention, the wellness model of our elderly and or people with profound disabilities who live in kind of nursing homes. And there’s some amazing projects that have been going on. I know South Yorkshire was one of the pilot places of nurses in care homes doing their prescribing because actually that then introduces an opportunity for care to happen in the home, but supervision and support that has to be wrapped around with that. And I was doing a piece of work earlier, just talking about the fact that we can’t expect people to work in isolation. And I know there’s a lot of dissatisfaction with, from sometimes from doctors that they feel that they’re the ones always having to give supervision. But I think what we’re trying to say on this call is actually there’s a number of us that are hugely experienced and we’re able to provide that supervision if we are enabled to do that within our role. And then to pick up from what Stef was saying about nursing being broader within kind of primary care. And again, within the practice I work, which is an area of high deprivation, we work with a lot of people who have got diabetes and we are on kind of regular contact with the diabetes specialist nurses in the hospital because we know that our patients don’t attend their appointments sometimes. So actually we’re bringing their appointments to them.with a specialist nurse doing joint clinics or with them actually giving advice over the phone. So it saves did not attends (DNA) at the hospital, but also it means that things are happening in the community closer to home where things make more sense. And it’s been happening for years and it’s been led by nurses for years. And I think the definition of neighbourhood is suddenly bringing all of these things to the forefront that have been happening for years. Like Joanna said, the things that we’ve been doing for such a long time are suddenly people are recognising them because there’s a new label for them.
David Purdue
Thanks, Anna. Joanna-
Joanna Vintis
I have a tiny point just to go back to what Stef said about general practice is for everyone. That I think is the biggest push we need to have in nurse education, that a general practice nurse does not have to be an adult-registered nurse. We see people before they’re even born, we’re doing pre-conception work with hopefully new mums coming in and we’re supporting patients right the way through. And then also we’re quite often seeing family members who are bereaved and we’re supporting them through that process. It is literally the most fulfilling career and it should not be the privilege of just adult nurses to get in on that. This needs to be open to learning disabilities, mental health and children and young people. We see everybody. Universities need to understand that as well. So there’s a big push to try and get universities to understand what a career looks like in general practice and community and all the other sectors as well, because this is where the good stuff happens.
David Purdue
I was just going to say that’s the bit around placement capacity then that we need to look at, don’t we, in terms of it’s not just an adult nurse thing, actually.
Joanna Vintis
The student tariff will always be the biggest barrier. It’s almost five times higher for medical student tariff than it is for other professions. We’re never going to get the same access to really high-quality placements if we don’t even that out.
David Purdue
Yes. Anna?
Anna Young
I was just going to say, we’ve noticed again and again within the advanced practice spectrum, I know Becky mentioned about using her advanced practice skills within home visits, that learning disabilities nurses that do their advanced practice, when you have advanced practitioners in primary care going out and doing the care home visits – the relationships that are built are so different because of the nursing model of relationship building and of leading and of education.
It’s night and day and all of the care homes say about how much better the outcomes are, the health outcomes has been a number of pieces of work around excellence and impact around the impact of nurses going out and doing this work. rather than the old model where somebody who might have had it tagged on to the end of the clinic rather than it being a role that actually they are expert in and they are really, really good at. So I think again, it’s reimagining, isn’t it, the art of the possible and actually recognising that primary care is so vast now and has so many different specialities and so much expertise. It’s more than what it used to be and it’s greater than what it used to be and greater in all its sense, greater in terms of the workload, but greater in terms of the potential and the expertise that’s out there.
David Purdue
Thank you. So, I’d like to ask, what do you want from me as your regional chief nurse?
Joanna Vintis
We’ll all giggle in the background and say money. Do you know, for me, what I would want is greater awareness of the training needs that we have in general practice. That’s the thing for me. You know, when policies come down and say, actually, we’re going to introduce this.
And if you ask practice nurses at the minute about immunisation changes there’s been changes since January that we’re trying to keep up to date with. So we need more dedicated training and development time, exactly like Anna was saying earlier. So protect that, protect our learning time, make sure we include our colleagues who are in the private and voluntary sectors as well in that so that they can be included. That’s my ask.
David Purdue
OK, Anna
Anna Young
Following on from that, the vaccination one is key. In these roles in NHS England and again across the strategic, we very often don’t have a general practice nurse background person. So when decisions are being made for things such as vaccinations, nobody has thought to ask what the impact might be on the ground to the people delivering this care.
So my ask is that you continue to open the conversation with the colleagues on the ground, with the nurses on the ground, with the clinicians on the ground, and support the structures that we’re developing to allow those through-flow of conversations in leadership back-and- to so that we know that we’re part of the decision making and your decision-making can be regarded by us as well. Thank you.
David Purdue
Thank you, Anna. Stef.
Stef Costa
Thank you. Probably I was the only one that wasn’t thinking about asking you for money, if that helps, because probably I do understand the difficult situations that we all are at the moment. But what I would say is that perhaps to support in the prioritisation of primary care nursing and how it’s perceived amongst the profession at system level and from other colleagues within the organisation, it’s to ask for support, to influence those links and those leads at all levels and to help in promoting the differences between what it is to be a nurse in primary care and community, because quite often we hear community and primary care terms used interchangeably, but they represent very different things with very different needs, with very different requirements. And quite often I’m seeing myself having to ask for clarification and not all the time the intention is aligned with the term being used. So I think it’s really important for people to understand what is general practice, that general practice is one of the elements of primary care and that primary care is different from community care.
And they’re all incredibly valuable, but they all have very significant differences with different needs.
With that, I would like to end to address probably what is known by everyone, that is the gap in leadership level that exists for the general practice nursing workforce that doesn’t exist in community settings or indeed in a hospital. And that gap in that leadership – it’s significant because even more so, roles such as yours, for example, it becomes more and more valuable to have the input and the influence in systems and in those that are making decisions about the nursing workforce to listen from influential leaders to consider primary care nursing and their needs since that gap in leadership is there. So I would say perhaps they ask for support, influence, education in clarifying terms and prioritising general practice nursing workforce.
David Purdue
Thank you very much, Stef. Becky.
Becky Weston
I’d like recognition for the advanced clinical practitioner role. We work as autonomous practitioners with prescribers, we do referrals, we do much the same work as GPs and I think that needs better recognition for all primary care nurses.
David Purdue
OK, so some good asks there, and some of them are more straightforward to do than some of the others. But I think the recognition part is really important. And we had our International Nurses Day celebration on Monday afternoon with presentations and one of those absolutely was from primary care because actually we do recognise the importance of it and we will look and work with you in terms of how we can support in terms of bringing you together – do some events.
So thank you all for your help. Thank you, Joanna. Thank you, Anna. Thank you, Becky. Thank you, Stef. That’s been a really fascinating conversation and thanks for all the work that you do every day.