General practice has approximately half as many general practice nurses (GPNs) as GPs and they are retiring nearly twice as fast as GPs. Most current GPNs came into general practice as a second career from either hospital or other community nursing posts.
What is the problem?
GPs and practices want to employ GPNs with significant experience of general practice to fill the huge gaps left by their long-standing highly-trained retiring nurses. A like-for-like replacement – they want them to hit the ground running to immediately help manage the growing clinical demands and challenges general practice is facing.
But here’s the problem. It takes many years of experience and training to achieve this level of competence, which makes these nurses very difficult to replace.
There has never really been a workforce plan to replace this ageing highly valued group of nurses.
GP habits die hard and if you look at adverts for GPN posts the vast majority still require previous GPN experience. Now increasing numbers of practices are fishing in the same pool, which often means they are trying to poach experienced GPNs from surrounding practices. This recycling only serves to de-stabilise other practices and produces losers for every winner.
While GPs continue to recruit experienced nurses from other fields they too need very significant induction and training in general practice to become productive and valued members of local health care teams. And, as other parts of the NHS system are suffering the same sort of shortages and workforce issues, this only serves to continue the recycling of existing nurses.
Grown your own
There is a different solution which is really working well - 'grow your own’.
We must encourage and support newly-qualified nurses to take their first career posts in general practice.
I have led the Health Education England Primary Care Workforce and Training hubs network (previously known as the Advanced Training Practice Scheme) in Yorkshire and the Humber for eight years. We now have nearly 250 practices (around 35% of all practices) in the region taking student nurses on a regular basis.
Some 512 student nurses spent between six and 16 weeks on GP placements through the Workforce and Training hub network in 2017/18. Our feedback shows that student nurses who have had a GP placement, shift their career intentions from around 30% to 90% considering GP nursing as a first destination career.
While attending local nursing careers fairs our training hubs are now being approached by increasing numbers of these students near to qualification asking how they can apply to become general practice nurses. This is a golden opportunity for general practice.
We have a new pipeline of motivated and energetic newly-qualified nurses who were so impressed with their placements in general practice and the role models of their supervising GPNs they want to follow a GPN career pathway.
All new nurses to general practice and in particular newly-qualified nurses will need robust induction and education programmes to give them the skills and confidence to grow as GPNs. The Workforce and Training hubs across Yorkshire and the Humber are working with local universities and primary care providers to improve and standardise the quality of and access to relevant educational modules and strong supportive relationships within the practice will be critical to nurture and develop these new GPNs.
The competency frameworks are out there and The NHS 10 Point Plan for General Practice Nursing suggests specific measures to ensure newly-qualified nurses are well supported and will have great career development.
There are also increasing numbers of bespoke schemes to help practices recruit newly-qualified nurses. In Yorkshire and the Humber we are in year three of the very successful GPN Ready scheme, which promotes and supports the successful recruitment of newly-qualified nurses to general practice posts and ensures they get the appropriate support and training for the job.
These packages are managed and facilitated by our network of Workforce and Training hubs and provide help to participating practices, from how and where to advertise their posts, to a comprehensive induction plan and monitoring of progress. Feedback from both practices and the new GPNs has been excellent
This is a win-win. Practices get to mould and shape the new GPN to their own needs and expectations and practice ethos
General practice is tending to attract newly qualified nurses who have been inspired by their GPN mentors and have high personal career expectations and see the value and satisfaction of the general practice approach to holistic care.They often want full-time or nearly full time posts and have the potential for 30 years plus service.
Investing in newly-qualified nurses in general practice should become the norm if we are to maintain the high quality, invaluable GPN services for the benefits of our patients.
- Dr Pete Lane is a GP in South Yorkshire. He is the clinical lead for the HEE Primary Care Workforce and Training Hubs across Yorkshire and the Humber (previously known as the Advanced Training Practice Scheme) and chaired the General Practice Nursing Workforce Development Plan released by Health Education England in March 2017