13 who joined after qualifying in 2018 . The sentiment is far from uncommon , Ms Gulam tells Nursing in Practice . ‘ Receiving it was so sad , because becoming a practice nurse is one of the most autonomous roles you ’ re going to get ,’ she says .
The 10-point action plan for general practice nursing , published by NHS England in 2018 , sought to increase student nurse placements , an ambition Health Education England ( HEE ) tells Nursing in Practice it is continuing to work towards ( see box , page 10 ). Ms Gulam thinks increasing the number of placements in general practice is crucial to changing student nurse perceptions and ultimately to boosting recruitment into the sector . At university she wanted to complete a final or elective placement in general practice , but this proved ‘ impossible ’ to organise , she says . But she welcomes what she sees as an uptick in student nurse placement , although this has not been ‘ entirely across the board ’. She also praises the GPN Student Nurse Network , which is active on social media and in higher education institutions , raising the profile of practice nursing as a driver of change .
Julie Carrick , director of nursing for GPS Healthcare , a primary care network ( PCN ) formed by the merger of six practices across Solihull , in the West Midlands , says the perception of practice nursing among students has ‘ improved slightly ’ as a result of such initiatives . However , she raises concerns that during the Covid-19 pandemic , placement capacity in general practice was reduced and practices were not even able to communicate with students as they normally might . ‘ I think we ’ ve got to keep fighting and keep pushing for more progress , but it ’ s obviously being stalled ,’ she says .
The fee paid to a practice for hosting a student nurse is still much lower than that for a medical student : around £ 3,856 a year compared with a minimum of £ 28,000 , paid pro rata per week . Speaking to the House of Commons Health and Social Care Committee on 1 March , Dr Emma Hayward , a GP and clinical educator in Leicester , raised the issue : ‘[ The tariff ] covers nothing in terms of student nurse supervision . That ’ s a whole new budget that needs to be established because otherwise we ’ re never introducing [ nursing students ] to the concept of primary care .’
Several nurses who spoke to Nursing in Practice also pointed to the elephant in the room when it comes to recruiting newly qualified nurses and nurses from other sectors to practice nursing : contracts are made with the employing GP , meaning pay , terms and conditions can be highly variable between , and even within , practices . In contrast , all non-medical NHS staff are on nationally standardised Agenda for Change ( AfC ) contracts . They believe this variation – affecting issues such as maternity and sick pay – may put off prospective practice nurses .
Investing in new nurses A nurse in general practice can manage long-term conditions including diabetes , asthma and chronic obstructive pulmonary disease ( COPD ), immunisations and public health work . Yet despite this complexity , there remains no mandatory GPN training for nurses who are new to general practice .
HEE took a major step towards improving training for new practice nurses in 2012 , when it commissioned De Montfort University in Leicester to deliver and test a ‘ Fundamentals in General Practice Nursing ’ programme . This is a university-level short course for qualified nurses , now funded across universities nationwide and covering bread-and-butter practice nursing skills such
There is a tangible drive to ensure education programmes are available to newly employed GPNs Dr Marie Hill
Are you considering quitting in the next year ?
No 33 %
Yes 67 % as long-term conditions management , immunisation and cytology .
Ms Carrick says the programme has vastly improved the education on offer to GPNs since she joined in 2007 . ‘ Before , everybody ’ s training was so different and it was a case of watch someone else do it and then carry on and do it yourself ’, or surgeries sending their nurses on a ‘ study day here , a study day there ’ without much structure , she says .
Allison Brindley , an assistant professor at the University of Nottingham , where she helps deliver the graduate entry nursing programme , was involved in the fundamentals course from the beginning . In 2011 , while working as a practice nurse in Loughborough , she and other experienced practice nurses joined the HEE steering group to develop the programme . ‘ I was excited to support the programme at De Montfort because the whole ethos was about experienced practice nurses training the next generation and making sure new-topractice nurses got the educational opportunities we didn ’ t get ,’ she says . Her enthusiasm did not fade : after completing her postgraduate certificate in higher education , she ran the course at De Montfort from 2016 until November 2021 .
Ms Brindley applauds HEE for providing the funding , without which she thinks the fundamentals programme ‘ never would have taken off ’. Previously , practices were ‘ poaching ’ experienced GPNs from each other , she says . They ‘ rotated staff from an already depleted pool of experienced GPNs and did not replenish the pool ’ because they were hesitant to pay for fundamentals training themselves .
Dr Marie Hill , senior lecturer in practice nursing at City , University of London , summarises how far educational opportunities have come overall : ‘ When I started as a practice nurse 30 years ago , the majority of GPNs would have begun their roles without any educational input . Whereas now , at least across London and the home counties where I am , there is a tangible drive to ensure education programmes are available to newly employed GPNs because the role is better recognised .’
However , the fundamentals course is not uniformly accessible ; there are limited places and nurses may still struggle to negotiate time to attend the course and study .
In addition , the pressure of staff shortages means not all new practice nurses receive the appropriate training , says Sarah Hall , steering committee member at the RCN GPN Forum . Practices are so ‘ desperate [ that ] there ’ s been a push to get people employed and trained quickly ,’ she says . ‘ I think from a safety quality perspective , it ’ s not good . From a retention perspective , it ’ s poor because nurses come in and feel unsupported .’
Career progression and training The pace of practice nursing is increasing , alongside greater time constraints and complexity , continues Ms Hall . As a result , the role is becoming more specialised . ‘ Twenty years ago , you could see everybody for everything – whereas now , and rightly so , it ’ s so complex that it ’ s impossible for one nurse to do absolutely everything and keep updated .’
Specialising in a clinical area such as health promotion , diabetes or asthma care – as well as undertaking training to enhance existing skills – is a development option for practice nurses . However , Joanne Charlton , a practice nurse in Worcestershire , says GPNs sometimes have to complete clinical training in their own time because practices will not release them .