Nurses embarking on a career in general practice nursing will now have access to voluntary standards of education and practice.
The new standards, published by the Queen’s Nursing Institute (QNI) have been designed to provide a contemporary and structured overview of expected best practice, standards and guidance for nurses at the beginning of the general practice nursing career pathway.
The standards also aim to give guidance to education providers developing introductory GPN programmes and specialist practitioner qualification (SPQ) programmes.
The QNI was commissioned by NHS England to develop the standards, as one of the actions arising from the strategic document, ‘Developing confidence, capability and capacity: Ten point action plan for General Practice Nursing’.
Leading experts in general practice nursing, including nurses, higher education institution (HEI) programme leads, training hub leads and current GPN students worked together to develop the new standards. The project was managed by Queen’s nurse Angie Hack.
In recent years, there has been a range of new educational developments for nurses moving into general practice. The evolving role of the general practice nurse with specialist knowledge and skills is ‘pivotal in contributing to the success of the transformation of primary care services’, the QNI says. However, this brings ‘unique challenges for nurses selecting general practice nursing’, because many GPNs are directly employed by general practitioners with variations in roles, responsibilities, terms and conditions, as well as variances in role preparation and continuing professional development opportunities, the QNI says.
Commenting on the rationale behind establishing the new standards, Ms Hack says that following the development of the QNI/QNIS voluntary standards for senior GPN education and practice over an 18-month period, ‘it became clear that there were major inconsistencies in approaches to GPN education and the dissemination of best practice in England’.
‘Additionally, there was evidence that the process for practitioners seeking to access and explore educational opportunities was very complex, whether as a new entrant to general practice nursing, a nurse interested in exploring a career in general practice nursing or an experienced GPN wishing to develop their role,’ she says.
Dr Crystal Oldman, chief executive of the QNI says that previously there were ‘no agreed standards’ for general practice nurses starting their careers. ‘The need for standards comes from their absence and the huge disparity across country as to what it takes to develop skills to become competent practice nurses and what is agreed that is needed.’
Dr Oldman explains that one of the challenges to developing new GPN skills is that they are employed by small healthcare businesses, which vary in the ways they train and develop their staff. ‘Some GP practices say GPNs must complete a course on new standards in their first year of working for them, while others say they don’t need to have them,’ Dr Oldman says.
She says when her colleague Angie Hack started to scope what courses were available for those new to general practice, programmes varied from four weeks to two years long. With that ‘completely unwarranted variation’, she says QNI needed to consult on what was required to be in a programme for new GPNs.
Until the general practice ten point action plan she says there was a ‘lack of attention’ about standards for GPNs. To address this, Dr Oldman says QNI consulted with professionals working in general practice, including practice nurses, educationalists, and those delivering programmes for GPNs, ‘to understand what was needed, to agree what the standards should be, and to build a programme that demonstrates how GPNs are meeting those standards’.
Dr Oldman says she is also ‘delighted’ with Ms Hack’s work on the standards, and that ‘it just demonstrates depth of her experience and knowledge critical to delivering this project’.
Ms Hack says GPNs in practice, HEI programme educators, training hub leads, experienced GPNs and student GPNs ‘have been instrumental in informing the development of the new standards, providing clear benchmarking to inform future GPN education and practice’.
While current general practice nurse education is not mandatory, the QNI says it is anticipated that Higher Education Institutes (HEIs) will adopt these voluntary standards as a best practice guide in developing future ‘Introduction to GPN’ programmes, to promote standardisation in length and content across England. The standards have been drafted encompassing four key domains of: clinical care, leadership and management, facilitation of learning and evidence, and research and development.
For Lisa Clarke, who was a GPN for over 20 years, and is a senior lecturer at the University of Wolverhampton, and a GPN qualification programme leader, there is ‘such variation in terms of availability of training for new GPNs and the support available’, so the standards are ‘an excellent framework for someone coming into a general practice nursing career’.
Ms Clarke says she is already familiar with the domains featured in the new GPN standards, having embedded QNI voluntary standards for senior GPNs into the university’s specialist programme for practice nurses. With a Masters in education, her research focussed on educational provision for GPNs. And her passion for primary care means she has already shared the standards with her practice assessors via a virtual meeting.
‘As time goes on, hopefully we will get more nurses reading about the new standards and taking on board the domains. There is something in everything in every domain that is critical to developing practice nurses,’ she says.
She believes the biggest barrier to making the new standards work, is ‘a lack of practice assessors and supervisors’. However, she says NMC standards for assessment in practice mean nurses’ supervisors are not confined to the role of nurse, but could be, say, a pharmacist, which means more nurses will have ‘another healthcare professional to guide their development through the domains’.
Using the terminology of the domains featured in the new GPNs standards will help ‘explore the understanding of their role with their patients’, Ms Clarke says. The standards will also help ‘guide GPNs’ practice and enable them to make therapeutic relationships with patients’, she says.
She also believes nurses new to general practice having this support provided by the new standards will ‘encourage their retention retain their role within practice and they will hopefully go on to further develop their knowledge and skills, and maybe go on to further positions in the future’.
Ms Clarke recalls how when she became a nurse facilitator for her locality ‘I was there to lead and manage others’.
‘At that point I’d oversee education and training for the locality of general practice nurses. If I had these standards now for me to support them within the domain of leadership and management, that would have enhanced my role to support others,’ she says.
During a time when the healthcare professionals have been under immense pressure as a result of COVID-19, the new standards are good news, Dr Oldman says. ‘These standards enable nurses to look at what they do.
‘Whether they have experienced hospital, community or care home working, general practice is a different context of care. And whether experienced or newly qualified these standards are a benchmark to test themselves, in their working environment.’
General practice nurses are ‘key professionals in delivering vital care to people of all ages in the practice population. They are also being called upon to adapt rapidly to the new conditions caused by the COVID-19 pandemic’, Dr Oldman says.
‘These new standards commissioned by NHS England are an important step in ensuring greater consistency of education and practice in this field, supporting the needs and expectations of nurses themselves, other members of the multidisciplinary team, and their patients,’ she says.