Identifying workload capacity in General Practice Nursing

This tool has been developed by Liverpool primary care trusts (PCTs) and provides a model for the calculation of practice nursing (Band 5 & 6) hours per general practice based on population size and patients with a long-term condition. It does not calculate the number of health care assistants (HCAs) and advanced practitioners per practice - the number of HCAs is calculated using a separate formula, whereas the number of advanced practitioners is considered as a substitute for a GP, and as such based on medical input required per population. The model uses a deliberate simplicity in order to enable widespread adoption.

Key assumptions

Basic practice nursing activity

One in four patients registered will visit the general practice for a basic practice nursing intervention once a year.
Weighted, not actual, population size is used in order to consider local health needs.
Basic intervention can be managed, on average, within a 15-minute appointment.
A Band 5 nurse is best suited to this activity.

Long-term conditions management

A total of 1.5 hours are required per disease process/patient/year – for example, a patient with two long term conditions has 3 hours allocated per year – this time can be divided as deemed appropriate (eg 6 x 15 min appointments or 3 x 30 min appointments).
General practice’s disease registers are accurate.
A Band 6 nurse is most appropriate for this activity.

Triage/first contact

This is not calculated as a discreet component but negotiated with the general practice, and is dependent on the current system in place to meet the access needs of the population.
Although this may commence as telephone triage, it should develop to face-to-face contact in line with nurse’s developing skills.
More senior nurses at Band 6 or above are likely to be most appropriate for this activity.

Working hours

Clinical sessions comprise 3 hours of patient contact.
Nurses work 45 weeks per year.
Whole-time equivalent (WTE) involves 10 sessions per week distributed as per model (ie 8 x clinical sessions,
1 x personal development session and 1 x practice development session).
There are 51 weeks per working year (this allows for shorter weeks at Christmas and New Year).

Calculation

Total activity

Basic activity

i. Patient population x 0.25 = number of appointments per year
ii. Appointments divided by 12 = patients per session
Long-term conditions

i: Number of patients on disease register x 1.5 hour = number of nursing hours per year
ii: Appointments divided by 2 = number of sessions
Triage/first contact

i: Sessions per week (telephone or face-to-face) as agreed locally
ii: Sessions per week x 51 = sessions per year

Total number of sessions per year = basic activity plus long-term conditions activity plus triage.

Nurses required

i: Sessions divided by nurse weeks per year = sessions/week
ii: Sessions per week x 51 weeks x nurse availability (assumption 2) = total nurses

Worked example

Practice A has a weighted population size of 5609.
1199 patients are on the validated disease register.
There are no access issues and therefore nurse triage/first contact is not a priority at present.

Previously, this practice had one WTE nurse to meet the needs of the population.

Calculation

Basic nursing activity
116.85 Band 5 sessions required per year – this equates to 0.325 WTE Band 5 nurse.
Long-term conditions
899.25 Band 6 sessions per year – this equates to 1.66 WTE nurse.

Total nursing needs = 1.985 WTE nurses – an additional 0.985 nurses than previously identified.