Emily Hutchison from Sonnet Advisory & Impact CIC shares findings from ground-breaking research commissioned by NHS England into the role and value of nurses in general practice in England. Findings from this research should be used to boost the profile of this branch of nursing that deserves more attention, support and investment.
Nurses are a crucially important part of the primary care workforce
Sonnet’s Leading the Way research (first report and second report) was the first to fully articulate general practice nurses’ (GPNs’) unique role and value. Explaining the role of nurses was, and still is, vital given that many nurses do not feel as if their role is well understood by both colleagues and patients (over 20% responding to our survey last summer felt this way).
In a far cry from the idea that GPNs simply support GPs in the delivery of care, in our third and final report involving practice staff across England, we found that nurses lead clinical services and play an important role in practice management. In most of the practices that we surveyed we saw nurses:
- Leading services for respiratory conditions (close to 9 out of 10 practices)
- Leading services for diabetes (close to 9 out of 10)
- Training and mentoring staff (8 of out 10)
- Managing staff (7 out of 10)
- Managing the ask of the QOF (7 out of 10).
We learned that nurses’ approach is distinct from those of others working in practices and is rooted in a curiosity about the patient’s situation and priorities. Nurses want to find out ‘What matters?’ for their patients, rather than focusing solely on ‘What’s the matter?’ with them. So aside from their expertise and qualifications, nurses bring other important qualities to primary care delivery, most notably curiosity and an interest and retained insight into each patient’s situation and priorities. Nurses provide holistic person-centric care and show respect for and primacy of the patient’s choices.
Nurses bring significant value to the patient community and to the practice
It is this approach by the nurses that generates value to patients, practices and local health systems. By following this approach, nurses deliver high quality and timely care, they support individuals to make informed decisions regarding their care, and they develop and lead services that are responsive to local population needs.
Nurses’ leadership and involvement in clinical delivery relieves pressure on other practice staff, particularly general practitioners. Across the country where nurses were involved in menopause support, minor illness clinical, long-term conditions reviews and management, the level of involvement of general practitioners declined. So nurses support the efficient and sustainable operation of practices.
“Nurses’ leadership and involvement in clinical delivery relieves pressure on other practice staff”
Besides operational advantages, nurses can bring huge financial value too. In our second report we explored the nurse-led transformation of diabetes clinics in 23 practices in Bath and North-East Somerset. This transformation generated social value of at least £5 million per year to practices and local NHS services. This value captured the capacity savings in NHS services in the local area. By ensuring that patients saw the right person with the right skills, nurses prevented patients’ conditions from escalating to the point at which they needed hospital-based care.
We could do more to support general practice nurses reach their potential
While nurses are leading the way across many practices in England, there are plenty of practices where nurses are not able to fulfil their potential and where, perhaps, their full potential isn’t recognised. This is the case in the:
- Two-thirds of practices where nurses did not lead cardiovascular services (nurse-led services are an ambition of the NHS Long Term Plan)1
- Practices where nurses did not lead frailty services (81%)
- Practices where nurses did not lead mental health services (86%)
- Practices where nurses were not involved in change management (67%), managing the ask of QOF (33%), staff management (32%), and staff training and mentoring (21%)
- Small but noticeable minority of practices (7%) in which nurses led no clinical activities.
We need more nurses in the front line of general practice, in roles where they have real authority and autonomy. In the context of a primary care system that’s under significant pressure with challenges in recruiting and retaining staff, it just makes sense that we should harness nurses’ full potential by allocating roles and responsibilities that are well within their capabilities. We recognise that there are barriers and risks to achieving this, not least difficulties in recruiting and retaining practice nurses.
“We need more nurses in the front line of general practice, in roles where they have real authority and autonomy”
We make the following five recommendations, and elaborate on them further, in our report that we believe will go some way in addressing these barriers and risks:
- Improve the offer to general practice nurses
- Nurses should be represented and empowered at every leadership level in the NHS
- Improve awareness and understanding of the GPN role
- Address nurses’ unsustainable workloads
- Continue research into practice nursing.
Some of these recommendations are easily attainable opportunities for practices to bring value to their operations whilst, at the same time, enhancing patient wellbeing. Some of the recommendations require change at the national level. Sonnet Advisory & Impact CIC will work alongside colleagues from NHS England over the coming months to promote our work and these recommendations.
“Help us bring about this change by sharing the research within your practices and health systems”
Help us bring about this change by sharing the research within your practices and health systems. Use it to explain your role and demonstrate the value you add to your practice. Use the recommendations to support change for nurses in your practice and beyond. The benefits of a general practice nursing workforce that is understood and supported to reach its full potential are significant – not just to patients but also to practices which stand to benefit from operating more efficiently and sustainably.
Emily Hutchison is an economist and social researcher at Sonnet Advisory and Impact. She leads their impact projects. In her 16+ year career she has worked in government and consultancy for organisations including CQC, Monitor, the Office for Budget Responsibility and Ernst & Young.
1. NHS Long Term Plan » Cardiovascular disease
