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Download printable version (pdf)INTRODUCTION
Unit One
General practice nursing Toolkit
The general practice nursing workforce has evolved from playing a subsidiary and almost invisible role in health care to taking on a leading position in achieving the reforms required for the modernisation of the NHS. Nurses who are employed in general practice are in a position, both opportunistically and through planned intervention, to influence the health status of the estimated 98% of the general population who are registered with a GP. The 1990 contract for GPs in the UK put emphasis on health promotion, and resulted in dramatic increases in the employment of general practice nurses (GPNs)* and their workload. The number of GPNs in England has stabilised over the last few years at just over 10,000 full-time equivalents or about 8 nursing hours per 1000 patients.1
Demand for primary care services has increased due to population ageing, rising patient expectations and national policies.2–4 Practice-based commissioning (PbC), and the new structure and organisation within the NHS for a patient-centred service, are continuing to increase the importance of the GPN role.5 As the abilities of nurses are recognised, there is an increasing shift of routine care from doctors to nurses, allowing GPs to take on more complex cases.6 The Wanless review suggested that up to 70% of the work undertaken by a GP might be moved to GPNs.7 This has major implications for the expansion of the GPN role, which already encompasses health promotion, family planning, treatment room services, minor-illness management and triage, and plays a major role in the management of chronic and long-term conditions such as coronary heart disease, asthma and diabetes.
The expectation is that GPNs working in extended roles will:
- enhance the quality of services provided by doctors
- safely substitute for doctors in a wide array of services, thus reducing demand for doctors
- reduce the direct costs of service provision.
As frontline staff, GPNs who work in primary care, where 90% of all patient contact occurs, have a fundamental part to play in achieving health care improvements and a patient-centred NHS.
In recognition of the importance of the GPN role, this Toolkit has been commissioned and created to highlight good practice in relation to GPNs in the following areas:
- employment practice
- education and professional development
- competence
- integration with the wider community health care workforce
- career development
- quality improvement and evaluating practice.
The Toolkit explores each of the areas described above from a variety of perspectives, depending on whether your main interest is as a GPN, an employer, a primary care trust (PCT), a patient or an education provider. Each section includes tools that can be downloaded to provide practical help towards improving practice.
The Toolkit has been commissioned and overseen by the Working in Partnership Programme and created by Staffordshire University. It has received extensive review from practices, PCTs, GPs, patient focus groups and GPNs.
* A general practice nurse (GPN) refers to all nurses employed in general practice.
References
- Walsh N, Roe B, Huntington J. Delivering a different kind of primary care? Nurses working in personal medical service pilots. Journal of Clinical Nursing 2003; 12; 333–340.
- Department of Health. The NHS Plan – a Plan for Investment, a Plan for Reform. London: Department of Health; 2000. Available at: http://www.dh.gov.uk/assetRoot/04/05/57/83/04055783.pdf.
- Department of Health. Liberating the Talents, Helping Primary Care Trusts and Nurses to Deliver the NHS Plan. London: Department of Health; 2002. Available at: http://www.dh.gov.uk/assetRoot/04/07/62/50/04076250.pdf.
- Department of Health. Investing in General Practice: The New General Medical Services Contract. London: Department of Health; 2003. Available at: http://www.dh.gov.uk/assetRoot/04/07/19/67/04071967.pdf.
- Department of Health. Commissioning a Patient Led NHS. London: Department of Health; 2005. Available at: http://www.dh.gov.uk/assetRoot/04/11/67/17/04116717.pdf.
- Horrocks S, Anderson E, Salisbury C. A systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal 2002; 324; 819–823.
- Wanless D. Securing Our Future Health: Taking a Long-term View; Final Report. London: Department of Health; 2002. Available at: http://www.hmtreasury.gov.uk./Consultations_and_Legislation/wanless/consult_wanless_final.cfm.