If there is one area of clinical practice that is almost entirely delegated to practice nurses, it is travel health services.
For the majority of surgeries, particularly where GPs have little knowledge or interest in the field, there is little doubt that patients are better served by a nurse-led travel health service.
However, this does not absolve the practice partners from responsibility for the acts of their employees, including the legal consequences of advice or immunisations.
If GPs are leaving the provision of travel health to practice nurses, this begs a number of questions: how can GPs be certain that the practice nurses have the necessary skills? How can they ensure that nurses have the basic training, how can that training be verified and what external indication can there be to ensure that the service that they are providing is of 'a reasonable standard'?
Whereas this might have been a difficult issue in the past, the recent publication of the Royal College of Nursing Competencies has simplified matters.
These competencies define the knowledge expected of nurses providing travel health services, listing standards required of a competent, experienced or proficient nurse and the high level of expectations of a senior practitioner or expert nurse.
These competencies are part of the Agenda for Change reforms which, although incorporated into the NHS, do not necessarily apply in general practice. Nevertheless, they apply to all nurses in all sectors.
This should lead to simple yet effective action by practices. The first step is to get hold of the competencies document. This is available in print form from the RCN or as a download from its website (visit www.healthcarerepublic.com for a live link). It is worth reading to understand the background and purpose of these standards.
It is essential that practice nurses are involved in implementation and that they are enthusiastic about documenting their competencies. Training courses, help with documentation and feedback and the introduction of new ways of working may affect the rest of the practice team, so they must also be involved.
The attainment of these competencies requires documentation and verification of skills. This might mean that a nurse needs to prepare a case discussion, attend training courses, develop feedback and use reflective learning methods. This will take time and will require extra support from the practice. In addition, high-quality travel services require time: a new patient can need at least a 20-minute appointment if he or she is planning a high-risk or complicated itinerary.
The competencies themselves provide a valuable resource and learning tool. A significant portion of the RCN document is designed to ensure that all staff working in travel health understand the importance of and are competent to deliver a pre-travel risk assessment. It is comprehensive and clear and sets out a standard that would be expected.
There are further resources in the document, including a practical A4 travel risk assessment form for patients to complete and list of available resources, with website links.
The RCN competencies encourage practice nurses to maintain their interest in the travel health that they provide, and promote feedback to the practice.
The competencies allow the professional development and autonomy of the nurses, provide verifiable standards, show that the practice is engaged in professional development and ensure staff have the requisite skills.
- Dr Ingram is a GP in Radlett, Hertfordshire, with a special interest in travel medicine
- Chiodini J, Boyne L, Grieve A, Jordan A. Royal College of Nursing Competencies: an integrated career and competency framework for nurses in travel health medicine.