'Primary care and general practice is really important, as there is such a huge potential for nurses in primary care,' insists Janet Davies, the new chief executive of the Royal College of Nursing (RCN).
We met with Ms Davies in the RCN Headquarters in central London and talk immediately turned to the topic of priorities for primary care nurses. In her first interview since taking the role of chief executive and general secretary from Peter Carter in July, we discuss the RCN's role in championing primary care nurses under her leadership.
'There is a real focus on primary care at the moment as a whole and it is not just about GPs, it's about the whole team, and nurses have a huge part to play in this,' she said.
Ms Davies identified that one of the biggest roadblocks in primary care is the lack of a clear career framework for practice nurses. 'We know at the moment that people can have the same title but have very different jobs. Some nurses in primary care have lots of opportunities for development in their practice and others don't. Some people get stuck in their role when they want to develop so it is about having a framework that people can use to expand their practice if they want to develop, get more senior roles, take on different roles and also attract more people to work in general practice.'
Ms Davies explained that part of this work meant that the RCN was involved with the development of Health Education England's (HEE's) upcoming general practice nursing framework, which is due for release this October. The framework will provide the practice and community nursing workforce with clear competencies and a pathway to encourage career progression.
She acknowledged that there were a number of issues restricting the growth and development of the primary care nursing workforce. These included the lack of students entering general practice, the increased caseloads of district nurses, the cuts to school nurses and the lack of career progression facing these nurses: the same barriers that have faced practice nurses for years.
We discussed boosting the profile of community nurses. 'It is quite amazing to me that we have had this rhetoric of care closer to home at the same time as reducing the number of district nurses,' said Ms Davies. 'The systems are not working together and it will prevent any aim of seven-day care closer to home [being achieved]. It won't work and can't work unless we've got good quality district nurses out there,' she said.
Ms Davies highlighted the lack of research on staffing as a major barrier to the community nursing workforce. In order for safe staffing levels to be correctly applied to community nursing, there needs to be more research into this. She stated that 'we need people to get involved in research again, and get involved with our students. There hasn't been much research into safe staffing at all in the community settings and there are lots of opportunities for that. We need to push for more evidence and research.'
When asked if there needs to be any other types of research into community and practice nursing, she said: 'It's not just about staffing and outcomes. It's about what we do as a nurse, it is about clinical practice and what makes a difference to patients. I don't think we've had enough research at all.'
Encouraging leadership
Something Ms Davies repeated throughout the interview was that nursing was a graduate profession and that nurses should take on more advanced roles to reflect this, as well as conducting more research.
The RCN had been championing advanced nurse practitioners for years she said, but there was still more to do. 'We are just completing a career framework, looking at the attributes of advanced practice, what that means, and ways we can recognise that within a framework. We will be promoting that even more in the future because we know that is going to be the answer to a lot of issues we have in healthcare at the moment,' she said.
Ms Davies is all for nurse-led practices and said that the RCN would support any nurse who expressed an interest in running a practice. She emphasised that there is no one model of primary care that can be used in every area.
A regular theme running through the conversation was that of empowering nurses to speak up and raise their voices to take on more advanced roles. This is something that Ms Davies' predecessor Peter Carter advocated in his final speech at this year's RCN Congress (IN, Peter Carter gives final speech, 20 July 2015).
She urged nurses to have their voices heard at CCG level and be more vocal about the difference they can make.
'I think nurses aren't represented on CCG boards as much as they should be,' said Ms Davies.
'There has to be a nurse on each CCG board but in some cases it is not a very strong presence and in some areas I think it is a bit tokenistic.'
She said that nurses needed to value themselves and their contribution and 'demonstrate to CCGs what it means to have a nurse in a leadership role in a CCG. When we have demonstrated that worth then there won't be any CCG thinking that they wouldn't want a nurse in that position.'
Moving forward
Talk turns to the future of the RCN and how Ms Davies will build on the undeniable success the College has experienced over the past few years under the leadership of Peter Carter.
'It is about building on our success, building our membership, making sure that their voice is heard, that we are very visible, developing our support for nurses, developing their practices, developing their education and supporting them in their employment,' she said. 'We want to build on this and go further.'
She expressed concern over the recent announcement of a pay freeze for nurses and that this might mean nurses who can't make ends meet may walk away from nursing into a different profession.
In terms of future projects Ms Davies didn't give much away but said that a key area the RCN will look at is building mentorship in primary care in order to place more students into primary and community settings. 'The other thing we will look at is the whole career pathway, and we will be doing a lot of work on the value of nursing.'
The conversation drew to a close as Ms Davies once again urged nurses to raise their voices to bring value to the profession. 'The strength of our profession comes from the voices of our 420,000 members, not just mine,' she concluded. IN