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The USP of General Practice Nursing
Kathryn Yates: Director of Primary Care Nursing and WTI Londonwide LMC
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Aim of session To share an overview of nursing in primary care
The USP of GPN’s Showcasing the GPN role Valuing professionals Recognising and retaining GPN Growing GPN talent Clinical supervision
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General Practice Nursing Forum For RCN members working in the field of general practice.
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Forums Membership In 2016 the forum was renamed from the Practice Nurses Association to the General Practice Nursing Forum Forum Membership Currently GPN forum have over 8,700 forum members
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Recruitment and membership
An increase of 1144 GPN members. New members have joined the forum at every event attended January 2015: 7577 April 2015: 7612 July 2015: 7653 October 2015: 7719 January 2016: 7800 January 2017; 8300 October 2017; 8721
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How the forum represents members
Developing standards and guidance for the employment of general practice nurses Supporting nurse revalidation Providing expert opinion about nursing in general practice to colleagues Working with national and regional organisations across the UK to support the growing GPN membership Enabling and engaging colleagues within and across primary care
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Communications Web update Bulletin Twitter Facebook
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RCN GPN Facebook RCN GPN Facebook group is one of the most active across the RCN forums and has membership in excess of 3800 active members.
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Workforce: Moving Forward
To meet changing needs, up scaling proactive interventions and prevention – requires a workforce with the skills to deliver this. Working with an informed public requires professionals to have a more enabling role, this requires a workforce that recognises the balance of power and sharing care How to ensure the right people, with the right skills, are in the right place at the right time, attention to the quadruple aim for all staff well being! Digital solutions, supportive enablers - smart phones, wristband technology, virtual platforms are shaping how patients, carers and the public interact with professionals, developing digital champions. Digital nurse champions. Genomics- responding to developments in treatments and interventions.
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Patients feedback “very positive” experience with general practice nurses
Practice nurses receive “very positive” feedback from patients in GP Patient Survey Nearly eight-in-10 patients (79%) reported that their practice nurse gave them enough time at their last appointment, and 78% of the patients said the nurse was good at listening. Nurses were trusted to tell the truth by 93% of people. UK's 'most trusted' profession Ipsos Mori 2017
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Context NHS Alliance ‘Think big; Act now: creating a community of care (2014) NHS England’s Five Year Forward View (2014) Implementing the Forward View: Supporting providers to deliver (2016) The General Practice Five Year Forward View (2016)… All identify General Practice Nurses(GPNs) as critical to the provision and co-ordination of an integrated approach to primary and community focused quality care
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NHS England’s General Practice Forward View (2016) references a general practice nurse development strategy which includes; Extra minimum £15 million national investment Includes improving training capacity in general practice Need to increase the number of pre-registration nurse placements Range of measures to improve retention of the existing nursing workforce and support for return to schemes Workforce and support for return to schemes for practice nurses 3 R’s
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Workforce Agenda: General Practice Five Year Forward View
Increasing training into General Practice Refining speciality training Increasing Physician Associate training and allied HP e.g. physio, paramedics Increasing nurse mentors into primary care to facilitate undergraduate teaching Development of care navigator skills and competencies Development funding to primary care for Practice Manager development Investment in General Practice Nursing Pharmacists working in general practice Training hubs = Community Education Provider Networks
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Community Education Provider Networks (CEPN)?
They aim to empower community organisations to work with higher educational institutions to assess workforce training needs, expand capacity for training in the community, innovate in the field of training and deliver multi-professional training. Their purpose is to understand and develop the community-based workforce, in order to meet the health needs of their local population They are designed to improve the quality and localisation of education for health professionals. CEPNs are networked arrangements of providers within a specified geography
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Health Education England (HEE) general practice nursing workforce development plan ‘Recognise, Rethink, Reform’ Purpose: to put forward a range of recommendations to support and develop the workforce for the future and to help nurses make effective career choices. Members representing HEE, NHS England, the Queen’s Nursing Institute, the Royal College of Nursing and the Royal College of General Practitioners formed a task and finish group chaired by GP, Dr Peter Lane, to look at four key areas: Entry into general practice – raising the profile as a first career choice and increasing the availability of training placements for students Establishing the role of the GP nurse – ensuring appropriate training and support is available for new GPNs Enhancing the role with professional development and career progression Expanding the healthcare support workforce with standardised training and career paths. Pre cursor to NHSE 10 point GPN plan published July 27th 2017
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Ten Point Action Plan for General Practice
The Ten Point Action Plan for General Practice describes the changes required to improve recruitment and retention, and encourage the return of nurses to general practice. July 2017
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Primary Care Nursing Align to the transformation of Primary Care
Enable primary care workforce development, recruitment, return and retain Promote primary care nurse leadership and research Align to the transformation of Primary Care STP, MCP, New Models of Care
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GPN workforce Demand likely to increase by 19% over next 5 years (population growth and activity) 39% GPNs over 55 years and 31% could retire by 2021 GPN workforce compensating for GP shortfalls Shortfall over 5 years equals 294 wte GPN 1 wte GPN =4,700 appointments per year 300 wte=1.4m appointments per year
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Mind the (generational) Gap
Jones K, Warren A, Davies A Mind the Gap: Exploring the needs of early career nurses and midwives in the workplace. Summary report from Birmingham and Solihull Local Education and Training Council.
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Skills vs roles, understanding the diverse nursing workforce
Facing the challenges and finding the solutions Shortage of mentors and some reluctance and support to become mentors by GPNs Non medical tariff often considered not reflective of practice /staff /mentor commitment Continuing myth that new registrants cannot commence career in general practice however if they don’ see it how can they choose it? Finding solutions to developing practice placements for student nurses Appropriate management of professionals especially those working at an advanced level of practice, working to the top of your licence (often reflected in pay, terms and conditions). Indemnity variation, career opportunities, pay, terms and conditions, managing professionals, working with other AHP’s Need to increase the number of practices offering placements for pre-registration nursing students, how can we achieve this at scale? Skills vs roles, understanding the diverse nursing workforce GPN, ACP, non-medial prescribers General Practice Working at scale The current model of small partnerships is unlikely to be fit for purpose. Current partner only model becomes problematic when GPs entering the work force do not want to work unlimited hours and expect a clear return for a contractually limited input. Smaller practices will not have the numbers to provide the skill mix, a longer term career structure Considering new models of ownership – increased salaried GPs per partner or limited company with shareholders.
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3 R’s In Action! Support, develop, refresh clinical supervision
Connect RCN GPN Forum, Practice Nurse networks Resilience, mental health and well being, supporting independent working Create leadership and development opportunities for all, Talent manage, for the majority not the few! Support for CPD, SPQ, Non medical prescribing, advanced practice, working safety within but the top of your licence Flexible working, good employer guides, support and time for revalidation Attention to pay, terms and conditions, need to develop a sustainable model, reduce poaching, recycling Peer support/ Preceptorship Facilitated career progression Value all experience and transferrable skills, new to GP, newly qualified, returners Scope your marketing and recruitment opportunities What can we do to engage all practices regardless of size and form to participate e.g. pre reg placements
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Enabling Student experiences into GP: Common Questions
What is the practice’s commitment Is there any funding- NM Tariff How many hours would be expected Would the student just be present or is it expected that they would be seeing patients (supervised) Would the practice have to provide mentorship/supervision/tutorials What is the practice’s responsibility towards the student What is the benefit to the practice Making the business case Seeing the value
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Consider… Mapping what looks good, what works and why
Valuing the practice team Clinical supervision Capturing the student experience Share, spread and publish Profile and recognise innovation in action and leadership at all levels
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Clinical Supervision
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Super-vision Binaural hearing (Listener’s ability) Binocular
( Wide field of view) Stereopsis! Author: Kathryn Yates
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Defining Supervision The unexamined work is not worth doing
Els van Ooijen, (2013) The unexplained life is not worth living ( Socrates in Plato, Apology:38 a) From “tunnel vision to supervision” Supervision enables clarity, to see and clarify the individual’s vision Each of us sees the world through the window of his thoughts (Chakravarty, 1997:12) Author: Kathryn Yates
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Why Clinical Supervision?
Clinical Supervision Policy Prevention of stress and burn-out Empowering clinicians through reflective practice (In/on action) Delegation, prescribing Managing expectation, internally and externally MCP; NAPC; NMC; Federations; Super practices, ACS Increased complexity, acuity, ways of working, new and additional/ advanced roles and practice across the primary care workforce. Improving quality, safety and educational standards improving patient/client/ carer care. Person centered Organisational changes (ongoing/constant) Gatekeeping Author: Kathryn Yates
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Overview of Supervision
Facilitates a shared purpose insight Inter-professional learning and development CQC requirement (within post 6 months) Reducing Risk Enhances the patient/person’s experience Reflects on patient/ client journey CQC statutory requirement To work effectively with the public Key element of the commissioning agenda To enable critical feedback Nurturing the internal supervisor Author: Kathryn Yates
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The ‘Ideal’ Clinical Supervisor
Skills Good listening skills Analytical skills Questioning skills Able to provide constructive feedback Able to empathise Observation skills Group facilitation skills (if group supervision) Able to keep the group boundaries Able to practice ethically and aware of organisational and professional codes of practice. Approach Person centred Holistic Believer in clinical supervision Committed to reflection on practice Facilitative style Experience Skill in clinical practice Active listening experience Experience as a supervisee Qualities Open Honest and trustworthy Good common sense Responsible Reliable Approachable Compassionate Good self awareness Consistent and dependable Congruent Warm Non defensive Good sense of humour Author: Kathryn Yates 29
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CS: Key factors to take away
Defining, reframing and understanding clinical supervision Recognise and reflect on the benefits of an effective clinical supervision for individuals, teams and the organisation/ system Identify and review resources, process and skills/ competences and attitudes that contribute to effective clinical supervision Where do we need to be…Review, Renew, Refresh Author: Kathryn Yates
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