Role of the general practice nurse in contributing to key functions of the primary care trust

Recognition of the contribution that the general practice nurse (GPN) has played in the delivery of primary care can help PCTs to develop appropriate delivery and governance structures. A core function of the role is the delivery of care appropriate to need, improving the health and well-being of patients.

Within Our Health, Our Care, Our Say, individuals are recognised as best placed to manage their own health needs through the promotion of self care, lifestyle changes and the development of effective strategies to manage their own health needs. Building on the long-term relationships that nurses establish with the population, the GPN’s role is fundamental in providing information and support in order to enable patients to make appropriate choices for their health.

Service provision from GPNs

Nursing within general practice cannot, and should not, be seen in isolation from other nurses but viewed as part of the whole system of care delivery. The development of key relationships with other nurses and clinicians working in primary and secondary care facilitates the delivery of patient-centred care (see Unit: Integration of general practice nurses and the community health care workforce, GPN Toolkit).
As a generalist, the GPN provides nursing services to a broad range of the population, often managing undifferentiated patient needs.

Key services include:

first-contact assessment
management of long-term conditions
promotion of choice and positive health.

Delivery of these services requires skilled, knowledgeable nurses who are responsive to patients' needs and expectations. This requires a flexible approach that makes appropriate use of skills and the importance of ensuring that the practice has enough nursing hours to provide the services that are needed. The general practice setting provides an increasing range of roles for both qualified and unqualified nurses (see HCA toolkit and Unit: Careers development of general practice nurses, GPN Toolkit).

All roles in general practice nursing should:

deliver high-quality, appropriate care in a safe and effective manner
listen and hear the patient's needs, and deliver care within this context
provide knowledge and support for patients, encouraging them to self manage
signpost and refer patients to other clinicians and services
be accountable and responsible for patients' care delivery.

Effective skill-mix, including the development and implementation of new roles, is fundamental to delivering
responsive services.

These new roles can be confusing for patients, particularly as there is a wide variation of titles used. However, they can be broadly categorised as:

HCAs
assistant practitioners
general practice nurses
senior general practice nurses
lead practice nurses
advanced practitioners.

Each of these roles should have clear functions, although the generalist nature of general practice does require some overlap, particularly at the margins of each role (see www.wipp.nhs.uk for the HCA and GPN toolkits).
Since the impact of increased diagnosis and effective management of long-term conditions will increase the
demand for nurse consultations, the mode of care delivery will need to change. This change will include the
development of closer working relationships with other organisations, for example leisure services. To support this, all nurses need to be valued for their own contribution and helped to realise their potential within a structured career pathway. The different roles that form part of the nursing team working in general practice are represented as shown in the schematic below.

Nursing Team Roles Schematic

Not all general practices will require a different nurse working at each level. Thorough analysis of population needs
against role definitions will determine the actual skill-mix required.

A GPN service includes:

services delivered to patients
nursing contribution to the practice organisation.

Services delivered to patients

Patients can expect competent care delivery from nurses working within the GPN service to deliver the services listed below.

Health promotion

Opportunistic and planned health promotion and education
Supporting patients to self care
Health screening
Specialist advice (eg family planning)
Women's health services (including cervical cytology and breast awareness)
Men's health services
Lifestyle advice, including smoking cessation, exercise and diet
Vaccination and immunisation
Travel health services

Management of long-term conditions

Identification, diagnosis, monitoring and management of patients with long-term conditions, including diabetes, chronic obstructive pulmonary disease, cardiovascular disease, hypertension, asthma, epilepsy and chronic kidney disease
Review of medication and adherence to treatments
Work within practice guidelines to monitor and advise patients on long-term conditions such as thyroid disorders, rheumatoid arthritis, iron-deficiency anaemia and pernicious anaemia
Support for patients with mental health problems
Undertake diagnostic tests and give preventative advice for high-risk patients
Prescribe medication after completion of a recognised extended nurse-prescribing programme

First contact

Undertake first-contact consultations and treat or triage, as appropriate