The value of nurse leadership for GP contracts

  • Guest blog

International Nurses Day 2023: Julie Belton is a nurse and Operational Director at Cuckoo Lane Practice, a nurse-led GP surgery in Ealing.

I run a unique nurse led APMS general practice for more than 6,000 patients. The practice has been in place for 16 years and was awarded an outstanding CQC. The advanced nurses employed here work across the full breadth of their competencies and qualifications and see the full range of patients presenting to general practice. We employ a GP for two to three hours each day but 80 per cent of our patients are seen and treated by advanced nurses, we are all qualified prescribers and take the patient through their health care journey. 

There are many unique skills and perspectives nurses can bring to partnership. Their Interpersonal skills enable good rapport and consultations with patients. A PhD study conducted at the practice identified these skills highlighting nurses’ abilities around explanation, enablement and information giving. Patients are firmly placed at the centre of care and those interviewed complemented our nurses open consultation style and their ability to create an impression of time (although consultations were no longer). Patients valued the ‘remembering and knowing them’ that the advanced nurses demonstrated. Nurses think differently, are good leaders and will add a new dimension to shaping an organisation’s direction. They are skilled at a mutual participation approach which means they are comfortable sharing power with patients and other team members. 

The practice has taken a different approach to more conventional GP led practices which works for our practice team and our patients. Most notable is a flat structure which assists with good working relationships. The hierarchy has been deconstructed and all staff and encouraged to participate in decision making.  Many staff at the practice work part-time so the meets twice every day for a five-minute, five-point huddle. Clinical, operational and strategic issues are raised and discussed.  Everyone has the opportunity to have their say. This ensures good team communication, open dialogue and everyone has a voice – staff feel their decision matters and this aids staff retention. 

Our reception area hosts a white board – an achievements board we refer to as glimpse of brilliance (GOB). This is where staff achievements are voiced, written up and congratulated. Staff reportthey feel they are invested in with a culture of continual opportunistic learning, they have a sense of team and belonging to the organisation, and are happy working in a well-structured and well organised team.  

My preparation to run a nurse led practice was a masters in organisational development and leadership which gave a good grounding. I have engaged in numerous senior leadership activities over the last 10 years and have been a Director of Ealing GP Federation board for eight years and nurse representation for Ealing LMC. I have been a clinical director for a PCN in Ealing for over two years. These activities have enabled me to build and develop an understanding of how the business side of things work. I would encourage other potential nurse partners to do the same thing.  

Cuckoo Lane Health Practice is unique but can definitely be replicated elsewhere.