1. The USP of General Practice Nursing
Kathryn Yates: Director of Primary Care Nursing and WTI Londonwide LMC

2. 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

3. General Practice Nursing Forum  For RCN members working in the field of general practice.

4. 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

5. 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

6. 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

7. Communications
Web update
Bulletin
Twitter
Facebook

8. 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.

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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.

20. 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.

21. 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

22. 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

23. 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

24. Clinical Supervision

25. Super-vision Binaural hearing (Listener’s ability) Binocular
( Wide field of view)
Stereopsis!
Author: Kathryn Yates

26. 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

27. 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

28. 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

29. 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

30. 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