10 | Nursing in Practice | Autumn 2023
funding , with practices being urged by the doctors ’ union to explain to staff that ‘ the money is not yet in their accounts ’.
The ongoing workforce challenge When asked about the challenges facing primary care and community nursing , Dr Oldman unsurprisingly names workforce as the ‘ biggest ’ – especially given the effects of the pandemic .
Like many other health leaders post-pandemic , Dr Oldman is worried about the impact of extreme tiredness among the workforce as a result of Covid-19 . She fears the consequences this could have for retention , retirement and working hours .
Where nurse shortages are present , patient care is rightly prioritised , she notes . ‘ But that means that the casualties of not having enough nurses are that education , training and development are usually the first things to go .’
The latest data from NHS Digital show a slight increase in the number of full-time-equivalent ( FTE ) nurses working in practices across England , but a small decline in the overall headcount – suggesting the working hours of GPNs are likely to have increased .
As of July 2023 , there were 16,952 FTE nurses working across general practices in England – up by 1.6 % ( 265 ) on July 2022 . But the overall GPN headcount stood at 23,369 – down 0.3 % ( 79 ) on the previous year .
The NHS Digital figures also show a large increase in the number of nursing associates working in general practices – a role funded by the Additional Roles Reimbursement Scheme ( ARRS ), which has added to concern at the QNI . As of July 2023 , there were 393 FTE nursing associates in general practices across England , a 44 % year-on-year jump .
Introduced in 2019 , the ARRS programme allows primary care networks ( PCNs ) to claim reimbursement for the salaries and some costs of hiring a number of multidisciplinary roles in practices . While nursing associate and advanced nurse practitioner ( ANP ) roles are included within the ARRS scheme , general practice nurse roles are not .
The QNI is set to survey GPNs to better understand the impact of ARRS and is keen to hear examples of where the scheme may be working well .
However , the institute suggests many practices are now employing large numbers of staff through ARRS and that this is having a detrimental impact on the existing GPN workforce .
Dr Oldman says GPNs are developing training and induction programmes for ARRS staff coming in and are also being required to supervise those in post , but without recognition or benefit .
‘ This is all on top of their day job ,’ she says . ‘ And there is no recognition for these core members of staff who make up the second largest [ group of ] clinical professionals in general practice – there is no recognition anywhere about what the impact [ of ARRS ] is .’
New SPQ standards ‘ changing the narrative ’ Among Dr Oldman ’ s priorities and key areas of focus is the rollout of the QNI ’ s new standards for community specialist qualification programmes to universities across the UK . In the summer , it published six fieldspecific standards for advanced community nursing education – including for general practice nursing , adult social care nursing , community children ’ s nursing , community mental health nursing , district nursing and inclusion health nursing .
Background
The QNI is a national charity that supports nurses in community services across in England , Wales and Northern Ireland . Dr Oldman joined in November 2012 as chief executive , having worked in the NHS for almost two decades . She also had an 18-year career in academia .
She was awarded a CBE in the Queen ’ s Birthday Honours List in 2017 for services to community nursing and her leadership of the QNI .
GPNs are required to supervise ARRS staff on top of their day job , with no recognition Dr Crystal Oldman
Three more are set to be published later this year , for health and justice nursing , community learning disability nursing , and community palliative and end-of-life care nursing . They are designed to be used by universities offering the specialist practitioner qualification ( SPQ ) and aim to build on the NMC ’ s own standards , released last year .
‘ This can only be good for the communities served , because you have got a national agreement and a national standard to meet when you are training .’
The new QNI standards are part of a wider drive around ‘ changing the narrative ’ for community care , which can be seen as ‘ less important than ’ hospitals . ‘ It ’ s not a competition , we are serving the same community ,’ Dr Oldman says . ‘ But unfortunately , for a multitude of reasons , community has been seen as less important and that does not send a good signal to student nurses .’
It is about ‘ nurses setting the standard ’, alongside patients , and ‘ recognising nine fields of practice as being areas that are nurse led ’.
The QNI is ‘ really pleased ’ about the way the standards have landed , according to Dr Oldman . ‘ It is just what universities want ,’ she says .