29
‘ minuscule ’ compared with what is offered for the supervision of medical students .
She says a medical student placement can attract £ 30,750 per FTE year , plus adjustments for local costs – more than six times the fee for a student nurse .
This , along with a scarcity of physical space , says Ms Caley , is ‘ one of the biggest barriers ’ to increasing the number of nurses coming into primary care .
‘ It ’ s an income issue . Surgeries haven ’ t got enough space for their own staff , let alone having students , so they will prioritise making space for a GP registrar rather than a student nurse .’
Ms Caley says her training hub and others across the country are topping up the tariff out of their own budget , resulting in a flat rate of £ 40 per day in Cambridgeshire and Peterborough for taking on a student nurse .
Adjusting the tariff has had a real impact on the number of students receiving placements , but it is ‘ not cheap ’, she says , and the extra funding is difficult to withdraw when it has been offered once .
And initiatives designed to boost the primary care workforce are making the problem worse .
ARRS ‘ takes the focus off nurses ’ Louise Berwick , director at South Yorkshire Training Hub , says the Additional Roles Reimbursement Scheme ( ARRS ) is making it much harder to secure nursing placements .
The hub previously ‘ prided ourselves ’ on the number of undergraduate nurses taking practice places , but ‘ it ’ s been more difficult to get those places because practices are supervising the new roles instead ’, she says .
Likewise , Emma Thompson , lead nurse at the South Yorkshire Training Hub , says ARRS has ‘ taken the focus off general practice nurses to the detriment of practices ’. The core issue , Ms Berwick explains , is that ‘ there ’ s only so much [ supervision ] capacity within a practice or a PCN , and its just a matter of how that capacity is used . ‘ The practices probably would have chosen nurses instead , but nurses aren ’ t on the list of ARRS roles .’ A number of different training hubs that spoke with
Nursing in Practice reflect similar concerns .
Practices do not have the space , staff capacity or financial incentive to increase numbers of undergraduate nurses entering primary care via placements .
Creative thinking This is not to say there is no hope of meeting the LTWP targets . Training hubs and universities are thinking outside the box to find new ways to meet the challenge . In South Yorkshire for example , which has huge demand for positions in primary care , an innovation hub is investigating how technology can solve capacity issues .
Ms Berwick said : ‘ The numbers in the workforce plan are huge and there ’ s no way they can be met with the capacity that ’ s out there at the moment , so we have to think differently about how we can achieve that .’
Likewise , Ms Caley ’ s nurse trainers in Cambridgeshire and Peterborough are using Microsoft Teams to support student nurses on placements to reduce staffing pressure on practice teams .
Higher education institutions are also exploring new ways of exposing students to general practice and helping undergraduates get a foot on the ladder .
The University of Cumbria launched a free remote learning module for nurses at all levels , aiming to introduce more people to general practice without being dependent on practice placements .
Senior lecturer in non-medical prescribing Janine Hill , who is leading the initiative , says it has taken students from ‘ walking through the door into primary care ’ to learning how to apply for jobs in practice .
Ms Hill also says there is ‘ a definite move towards the use of simulation ’ in nurse training for general practice .
‘ We have to think outside the box because there aren ’ t enough nurses , so we have to be flexible and creative .’
Yet , as she points out , even with the best recruitment campaigns and the most innovative uses of technology , the LTWP might still fail if a deeper problem in general practice is not addressed .
Pay needs consideration Since general practices remain private businesses , pay as well as terms and conditions are often notably worse in primary care than in secondary care settings .
Those who spoke with Nursing in Practice say this makes it more difficult to attract new nurses , and to retain the experienced staff who are vital for training .
Ms Hill says her personal view is that ‘ if [ the government ] wants nurses going into primary care they need to be considered to be on the same [ Agenda for Change ] financial bands ’.
‘ You ’ re not offered the same remuneration or expectation , or sick pay and holidays . So , if people are to move from one area of the NHS to another , there has to be an understanding that there will be similar pay .’
At North Central London Training Hub , Ms Gerrans agrees that ‘ terms and conditions can be a significant barrier as they ’ re rarely equivalent to Agenda for Change ’. This is also a concern that extends beyond primary care and into the wider nursing workforce .
Recent UCAS data 3 show acceptances to nursing courses in England were down 13 % year on year , increasing the recruitment challenge even further .
Mr Shembavnekar of The Health Foundation warns this could signal a wider ‘ image issue among students of nursing being a rewarding career ’.
Additionally , rising dissatisfaction with careers in nursing feeds into higher turnover rates and more experienced staffing choosing to retire early .
Mr Shembavnekar says this in turn becomes a ‘ major constraint ’ on increasing placement capacity , as the system loses the experienced nurses required to train the next generation .
Catherine Lawlor , lead practice nurse for South East London Training Hub , worries that even with a successful workforce expansion , these issues may ultimately undermine the LTWP ’ s expansion aims .
‘ You can throw as much money at it as you like but if you don ’ t have the teachers , you don ’ t have the teachers .
‘ My concern is that you aren ’ t ensuring that the training necessary to provide a safe standard of care is going to be available . There was a lot of talk about expanding placements [ in the workforce plan ] but no real understanding of who was going to provide the training .’
Ms Lawlor says she fears a rush to meet the commitments in the long-term plan might leave general practice with a workforce that is significantly less experienced , without securing the experienced nurses need to provide training .
While training hubs say the workforce plan is a step in the right direction for rebuilding the workforce , there are still concerns about its implementation .
Without more flexible thinking about how to train nurses , or significant investment in training capacity , ministers risk missing the LTWP ’ s targets , or hitting them in a way that , as Ms Gerrans cautioned , makes it hard to maintain quality and safety standards .
There ’ s a lot of talk in the plan about expanding placements but no understanding about who would provide the training Catherine Lawlor