Speakers' Corner: Dr Crystal Oldman, Chief Executive, The Queen's Nursing Institute on the London challenge for general practice nursing

Dr Crystal Oldman, Chief Executive,
The Queen's Nursing Institute.


See Crystal speaking at our conference below. You can also read the thoughts of Gill Rogers, Londonwide LMCs' Director of General Practice Nursing, on maintaining and improving general practice nursing care for patients

The Queen’s Nursing Institute (QNI) is a charity that works with all nurses who work in the community and primary care. We champion the vital work that they do, but we are increasingly concerned by the mounting challenges facing this dedicated and skilled workforce.

The issues facing the nursing workforce in London mirror those of the rest of the UK but there are, as always, more specific issues to working in a major city, not least of which is the cost of living for those professions which are on a relatively low salary.  But there are other issues facing the nursing workforce in London – and the community and primary care nursing workforce specifically.

Getting the right workforce and skills mix

The QNI’s recent survey of 3,405 nurses working in General Practice (GPNs) shows that the new service models articulated in the Five Year Forward View are unlikely to come to fruition at scale unless there is significant and sustainable investment in the development of the primary and community care nursing workforce.

GPNs reported a 43% shortfall in the skills required to meet the current demand in GP surgeries across the UK and in London this reaches 64%. Over one third of the nursing workforce in primary care are due to retire by 2020, contributing to an overall picture of primary care facing a workforce crisis.

Added to this, there is a workforce crisis in the District Nursing (DN) service, with the figures from the QNI national survey in 2014 showing that 25% are due to retire by 2020 - and against all the evidence of need, a predicted reduction in the commissions for preparing new District Nurses.

It cannot be emphasized strongly enough that it will be impossible to realize the vision of more care being delivered at home and in communities without a skilled community nursing service that is expertly led and managed at a local level. There are actions that can be taken and the QNI would welcome support of London GPs in this.

Building the workforce with high-quality placements

We need the universities that deliver nursing programmes to plan for more placements to in the community and primary care. There is evidence that when students have a good placement, they want to return to work in that setting when they are newly qualified. It is the most effective recruitment method and one that is not widely used by GP surgeries. The QNI report showed that in the UK just 27% of GP practices offer student nurse placements, but in London this falls to just 19.6%.

The QNI is undertaking a nine month project this year, funded by Health Education England (HEE), to identify innovative approaches in student placements in primary and community care, so these can be shared, alongside the barriers and enablers, to provide inspiration in support of the next generation of GPNs. We would be delighted to hear about innovations in London and equally we hope there will be examples from across England that will be helpful for us to share with you in due course. Our QNI project manager for this work would be delighted to hear from you about any placement learning innovations you are supporting. Please contact project manager Mary Saunders: mary.saunders@qni.org.uk

An investment into placements and in the development of qualified mentors to teach and assess the student nurses is also required, to support student nurses. Local HEE education and training boards (LETBs) can advise on how this can be done and the developing Community Education Provider Networks (CEPNs) can also help with the support of this work.

Supporting nurses working in general practice

The QNI has online learning resources to support nurses who are new to working in primary care and in the community. These resources have been written by university lecturers and practitioners and have had thousands of downloads and excellent feedback since they were launched. Please do encourage your teams to support nurses new to working in primary care to access these resources. They can be useful for supporting student nurses on placement too – a real bonus for a busy mentor!

In terms of post qualifying developments, the HEE career framework for General Practice Nursing and District Nursing published last October provides an excellent overview of the expectations of the roles at each level.

In relation to the higher end of this framework, we urgently need to develop more Nurse Practitioners (NPs) in primary care to address both the shortfall in nursing skills and also the current shortage of GPs. Nurse Practitioners can assess, diagnose, prescribe, treat and refer patients and they could provide the much needed growth in capacity within primary care.

The value of training and education at the higher level in District Nursing must also be recognised and it is alarming that the financial support for the development of the DN role may soon be subject to a significant reduction. The QNI published evidence in December 2015 on the value of the District Nurse qualification – to patient outcomes, to families, carers and to the wider team.

The future of nursing

Nursing overall faces an uncertain future with the proposed introduction of tuition fees and the loss of the bursary from September 2017. The worst case scenario is that we do not fill the required number of places to meet the needs of patients – and we lose the mature students who bring so much self-confidence and life experience to their roles in primary and community care when learning to work autonomously with patients and communities.

On a positive note, nursing does remain one of the top career choices for school leavers. I have spent the last 40 years in a career I love, which started when I was still at school when I had a job as a ward orderly at weekends in the local District General Hospital. In leading the QNI I am doing all I can to support the next generation to have an equally rewarding career in their roles in community and primary care. Please do keep up to date with our work at the QNI.

Dr Crystal Oldman speaks about the role of general practice nursing at Londonwide LMCs' Annual Conference


Last updated : 25 May 2016


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