It comes at a time when there is no common understanding across the NHS of the true value that nurses bring to general practice.
The research report, which looks at what is being achieved in general practices across England, reveals four main arenas in which GPNs create value – within practices, with patients, amongst the community and across the wider NHS – and affirms that GP nurses provide expert clinical care, take a lead in helping patients manage their health conditions and act as a ‘super connector’ between other healthcare professionals within and outside the practice.
It finds that, whilst the clinical knowledge, expertise and skills required by general practice nurses are ‘vast’ and ‘complex’, the role is often poorly articulated by GPNs and underestimated by others.
The research has informed a new framework through which the value of general practice nurses can be fully understood and articulated, whatever the size of the nursing team or the specific duties of any one nurse.
The framework includes eight factors that drive value, developed by exploring the arenas in which value is created and identifying the key drivers of that value – the things that nurses do, the approaches they take and the skills which bring about positive outcomes. The report showcases GPNs themselves as a workforce of skilled, confident and resourceful professionals, working independently with high levels of autonomy and authority to deliver expert patient care.
Jim Clifford OBE, director and CEO of Sonnet Impact, said: “General practice nurses have stepped into the limelight during the pandemic and, in the face of challenge and uncertainty, they have provided a reassuring and constant presence – adapting their ways of working; providing face-to-face care for patients despite risks and restrictions and being ready to answer the call to administer vaccines the moment they were approved.
“Never has it seemed more appropriate to take a proper look at the vital role of nurses in general practice – to look, and to fully appreciate the significant value that they create every day, in every community, for every one of us. This is not a role formed from an overlap of other disciplines, but a clear, identifiable discipline in its own right: one without which primary care is incomplete.”
Dr Hilary Piercy, associate professor in the department of nursing and midwifery at Sheffield Hallam University, said: “In light of both the evolving shape of the NHS and the demographic and economic challenges faced by society, the role of general practice nurses demands to be better understood – by nurses, by other healthcare professionals, by the general public and by decision makers in Government.
“Without a full acknowledgement of how important GPNs are, and the extent of their potential value to the wider system, we risk both de-valuing the profession and actively reducing the extent to which GPNs can bring about positive value to society (a significant opportunity cost).”
The report has been commissioned by NHS England and NHS Improvement as part of the General Practice Nursing Ten Point Plan, to encourage further investment and development of the profession.
Dr Crystal Oldman CBE, chief executive of the Queen's Nursing Institute (QNI), said: “This is an excellent and comprehensive analysis, which provides a wealth of evidence about the huge value and potential of general practice nurses in primary care today. It will require close reading by policy makers, those who employ GPNs and anyone involved in commissioning and delivering population health in the community. The appendices to the document provide a useful compendium of data and information about general practices in diverse locations as well as robust financial models.
“The report links strongly with the work carried out by the QNI and the author Suzanne Gordon, in articulating the work of specialist nurses in the community and the financial value they bring to integrated health services, delivering high quality, holistic care to individuals, families and communities. As such the report will be of interest to all nurses in the field of general practice and will be promoted widely by the QNI and the Association of Academic General Practice Nurse Educators.”
Heather Randle, professional lead for primary care at the Royal College of Nursing, said: “During the pandemic we have seen GPNs stepping up, supporting their patients and the wider NHS, and adapting their practice in ways that we could never have imagined, yet they have felt invisible and undervalued by other clinicians and the public. This report highlights the diverse skills , expertise and leadership of the GPN and how key they are to the future of the NHS and General Practice.
“We must not underestimate the role they play in supporting their local population and the wider health economy including preventing hospital admissions and leading public health. This report can move some way towards a better understanding of the role of the GPN especially as we look to the future and the new models that put general practice at the forefront of community practice.
“The Royal College of Nursing welcomes this report and looks forward to seeing the role and value of GPNs celebrated now and in the future.”
GPNs are registered nurses working across range of roles and specialisms, and are often the first point of contact for healthcare for most people. They make up almost a third of the general practice clinical workforce.
Routes into the profession vary, and the study cites family-friendly hours as a primary reason for nurses moving into general practice.
Other reasons include the attraction of a clinical focus, the privilege of getting to know patients and their circumstances well, and the opportunity to provide continuity of care in a holistic and person-centric way. It is uncommon for nurses to enter general practice immediately on qualifying, and a scarcity of general practice placements for undergraduate students is believed to be one of several key contributors to this pattern.
The future of the NHS is built upon a firm foundation of primary care and this research has shown that primary care relies on GPNs. Without a renewed focus, adequate funding and a pipeline of new nurses into the profession, the potential impact of GPNs is likely to be only partially realised. The report finds that this would be ‘nothing short of a disaster’.
An illustrative case study from report:
“A man in his 40s had asthma and diabetes. He was insulin dependent. Despite the efforts of the surgery to support him in managing his conditions, he didn’t respond to invitations, and rarely attended of his own volition. The clinical team knew he struggled to control his diabetes, was over-using his reliever inhaler (Salbutamol) and not taking his preventer ones, meaning his asthma was poorly managed.
“The practice nurse realised a different approach was required. She made contact by telephone and had a good conversation, realising through her experience in mental health care that he had difficulties in this arena as well. As his trust grew during the conversation, the patient told her that he had had talking therapies in the past. After the call the nurse spoke with the mental health team and discussed with the GP how best to manage the patient’s needs whilst avoiding the need for a separate GP appointment (which the patient was unlikely to attend). Armed with that information she was able to have an appointment with him covering all his conditions in a holistic and natural way. Talking him through and practicing blood sugar monitoring and encouraging an informed use of insulin, and developing his understanding of how to manage his asthma using his preventer inhaler, she handled the patient’s clinical and self-care needs and was able to work with and around his mental health needs.
“The nurse has since built on that engagement and has been able to follow up to support the patient’s ongoing care. With a better understanding of his condition, and proper use of his preventer inhaler he is not waking up at night, breathless and worried with his asthma kicking in. He is using his insulin regularly and appropriately, and feeling that he is in control. Appropriate and tailored support has been accessed for his mental health condition.”
