GENERAL PRACTICE NURSES

Unit Two
Employment from a general practice nurse’s perspective

This is an exciting time to be a GPN. The NHS Plan1 emphasised the importance of primary care, which is usually the first place a patient contacts when feeling unwell, and how services will move from secondary to primary care.

The current model of health care provision is unlikely to be sustainable,2 and therefore increased emphasis is being place on encouraging patients to take responsibility for their own health. The Expert Patients Programme,3 which encourages patients with long-term conditions to manage their condition better, is driving this change in emphasis. With appropriate training and support, GPNs will have the knowledge and skills in patient education to help with this change in direction.

The Nursing and Midwifery Council (NMC) Code of Professional Conduct4 stresses that nurses must:

• be aware of their own levels of competence
• always work within their own competence levels, in order to maintain professional standing and ensure patient safety.

This is a matter of high importance as the role of the GPN is expanding and moving across the traditional boundaries between nursing and medicine.

 

 

If you are already employed in general practice, you will be keen to know that all the policies and procedures that the practice has are up-to-date and in line with current employment law. If you are hoping to start a career as a GPN, you will want to know the best way of finding the right job for you.

Person specification and job description

Before advertising the GPN post, the practice will have profiled the needs of the patient population to enable this to be matched with nursing provision. A person specification will be produced, which will relay the kind of personal qualities that are needed for the job. See Tool - Person specification for GPN role . Looking at some real-life examples of person specifications linked with job descriptions will help you to decide if you are suited to the post. In addition, the practice should provide a job description.
Tool - Job description examples for GPN roles

The job description will clearly identify the type of role that you are expected to take on, although this may be reviewed each year at your annual appraisal. As there is so much variation in the role of a GPN, you will need to read the job description carefully to determine whether or not this is the right job for you. Some roles will focus mainly on long-term conditions - for example, managing clinics and monitoring patients. Others will have an emphasis on seeing patients who present with symptoms of minor illness and require same-day appointments for advice or treatment.

Consider whether the practice needs a GPN who is qualified as an independent/supplementary nurse prescriber. All nurses who are qualified to prescribe should also have associated skills in assessment and diagnosis. Nurse prescribers are able to prescribe any medicine within their scope of practice, with the exception of controlled drugs, which they are able to prescribe on a clinical management plan as a supplementary prescriber with agreement from the GP. Do not confuse the qualification of independent or supplementary prescriber with the community practitioner prescribing qualification (V100) held by nurses with a district-nursing or health-visiting background. This qualification will only entitle GPNs to prescribe from a very limited formulary (predominantly dressings).

Terms and conditions

In addition to your job description and job offer, you will be given the terms and conditions of employment. Although you might be able to negotiate some changes before you sign the contract of employment, these terms and conditions, for example hours of work, pay and holiday entitlement, will become legally binding once both parties have signed the document. For an example of what to expect, see
Tool - Terms and conditions of employment: what should GPNs look for?
and Tool - Example of a contract of employment for GPNs .

Your contract should be given to you within 2 months of you starting work for the practice. Keep it in a safe place. This could be kept in your personal development review folder, as it is sometimes useful to refer to the job description when considering your performance over the past year at a review.

Levels of pay

Some GPNs may be employed by primary care trusts (PCTs), but more and more GPNs are now employed directly by the GP practice. As an employer, the practice can therefore determine the levels of pay.

The Royal College of Nursing (RCN) strongly believes that nurses and health care assistants (HCAs) employed in general practice should be employed on Agenda for Change (AfC)2-4 terms and conditions. The new General Medical Services (nGMS) contract also encourages this practice.5 AfC provides a uniform package of terms and conditions, and should form a stronger link between the rewards and the demands of any given job. It is intended to replace clinical grading for nurses, and the terms and conditions as set out by the Whitley Council. It is a modern pay-and-conditions framework based on the principle of equal pay for work of equal value. AfC links with the NHS Knowledge and Skills Framework, which outlines the competences required for various roles. See Unit 3: Competences of general practice nurses for more information on adopting AfC.

The practice may not have implemented AfC in its entirety, but adopted some of its principles, such as similar pay scales and holiday benefits. See Tool - Job descriptions for GPN roles to compare your own post with others that have been banded according to AfC - this will help you gauge how the practice views the post. Practices may wish to work together across localities to agree the implementation of AfC as this could reduce the risk of nurses moving between practices.

Pay reviews

The following questions should be asked regarding pay reviews:

• when do they happen?
• how often?
• what are they based on - competences, changes in role or just a blanket percentage increase across the practice?

 

Applying for a GPN post

Having found a post you are interested in, it is a good idea to make an appointment with the practice manager to undertake an informal visit and see whether the atmosphere and facilities of the practice suit you. Find out whether the employment is via the PCT or directly with the practice. General practices vary tremendously from large partnerships in medical centres with 10-12 GPs, who may have a team of GPNs and HCAs, to single-handed practices where you are likely to be the only GPN.

Different working environments will suit different people and personalities. Some GPNs thrive on working as part of a large practice team, interacting with their colleagues as a constant source of support and advice. However, others enjoy working in relative isolation so that they can work as they wish to with limited interaction. Ask for an informal visit to get a feel of the ambience of the practice and spend time talking with the reception staff, nursing team and GPs. General practice teams vary enormously and taking the time to find out what's right for you will pay dividends. See Tool - What sort of practice do you want to work in? to consider the advantages and disadvantages of working in various types of practice.

Your application may involve sending a copy of your curriculum vitae (CV), which should clearly demonstrate the skills that you can bring to this post. See Tool - Example of a general practice nurse curriculum vitae for an example of a CV that provides evidence of suitability for a GPN role and
Tool - Hints and tips on compiling your CV for advice on how to write a CV.

Interview

Remember that interviews are a two-way process. It is not only an opportunity for the practice to assess what you can bring to the job, but an opportunity for you to see if you would like to take the job if it is offered.

Induction

As part of the induction programme, you need to agree your training priorities and an action plan for your professional development. Everyone has a different experience of induction when joining a new employer. Induction is your introduction to the practice, and hopefully will be more than just a warm welcome and where to put your coat, although these things are important.

There are three key areas that you should look for, which are detailed below.

1. Role information

This will help you to get to know all about your new role and the responsibilities you will have, including health and safety, and what will be expected from you on a day-to-day basis. Is there an induction booklet with a plan for your first month? Has any training and development been organised for you? Although the practice will have checked that you have current registration with the NMC, they may wish to satisfy themselves of your clinical competence. You may be observed by a senior GPN or GP, who will check your training qualifications and skills, in order to ensure that the best service is delivered to patients.
See Tool - Sample induction programme for more details.

No-one will expect you to know everything when you start. However, they will expect you to be honest about your current capabilities (in adherence with the NMC Code of Professional Conduct6) and you should be willing to learn new skills. If you have never worked as a GPN before, you should contact the PCT to find out what introductory courses are available. If there is limited information available, you could contact the nursing department of your local university to find out whether or not they run any useful courses that you could access.

2. Support information

Mentorship is a key component in supporting new staff and access to one should be agreed at your interview. Having a mentor who is designated to provide support and advice will help you to feel more secure. Ideally, this should be another GPN. However, if you are the only GPN in the practice, you will have to ask for a mentor from outside the practice. You should not be content to use the GP as a 'buddy' - you need to have support from a fellow GPN who understands the nursing ethos and the NMC Code of Professional Conduct.6 See Tool - Mentorship and buddying scheme for more details.

3. Organisational information

Getting to know the culture and the key goals of the practice will help you to understand why things are done the way they are. You should arrange to spend some time with the practice manager to understand systems of payment, working practices and targets that need to be met. Understanding the nGMS contract5 will help you to appreciate why the practice may be so keen to reach some of the targets in the Quality and Outcomes Framework.7 Remember that GPs are independent contractors and this makes a big difference to the set-up of a practice, compared with the organisation of a hospital.

Employer’s liability:

Vicarious liability and the responsibilities of the practice/employer

Employers have vicarious liability for the action of their employees as long as:

• the employee was acting in the course of their employment (time, place etc)
• the employee was doing a job which they are employed to do
• the employee works within the employer’s policies.

Employee’s indemnity cover

Employees may have their indemnity cover provided by their employer, but when nurses are self employed, advice should be obtained from the Royal College of Nursing (www.rcn.org.uk) and the Medical Defence Union (www.the-mdu.com).

 

 

 

References

This document is intended as a guide only.
© Crown Copyright September 2006.
The text in this document may be reproduced free of charge in any format or medium providing that it is reproduced accurately and not used in a misleading context or used for commercial gain. The material must be acknowledged as Crown Copyright and the title of the document specified. Where others have been referenced on specific documents and tools, the organisation must be acknowledged in full and the title of the document specified. All links to external websites have been provided for your information and the Working in Partnership Programme take no responsibility for any material or content accessed on any such websites