14 | Nursing in Practice | Spring 2022
‘ This increased experience is also not backed up in a pay scale ,’ she adds . ‘ You have to ask for pay rises .’
Meanwhile , leadership opportunities may include becoming a nurse partner or lead practice nurse within a practice or CCG , and there are now also leadership opportunities in training hubs . These are ‘ slowly but surely increasing ,’ continues Ms Charlton , although she notes there is no nurse on the board of her local PCN . Ms Gulam echoes the sentiment : ‘ Within PCNs , I had to push the idea that there should be a nurse involved . We ’ re so often just hidden behind doctors . I feel we ’ re nowhere near having the voice we deserve yet ,’ she says .
Ms Hall highlights the increased recognition of practice nurses ’ leadership potential since the pandemic – during which , for example , they ‘ shone ’ managing vaccination clinics . ‘ Practices have started to realise what they ’ ve got and those that don ’ t listen will lose their nurses ,’ she says . However , she shares concerns over ‘ practice nurses not having enough of a voice in PCNs ’.
Advanced clinical practice ( ACP ) is also a well-trodden route for practice nurses to develop leadership and clinical skills – as well as increase their pay . However , Ms Brindley fears many may be ‘ shoehorned ’ into it . The ACP or advanced nurse practitioner ( ANP ) role is closer to the ‘ medical model of care involving seeing patients , diagnosing , treating and prescribing ’, she argues . Sarah Weaver , course leader for the postgraduate certificate in general practice at the University of Winchester , echoes this view : ‘ In a way , ACP training takes you away from the practice nurse role , so there need to be other forms of career progression .’
Meanwhile , multidisciplinary teams in general practice – including paramedics , nursing associates and pharmacists – are expanding , encouraged by recent funding for PCNs through the Additional Roles Reimbursement Scheme ( ARRS ). This change is seen as both an opportunity and a source of frustration by practice nurses .
‘ Where ’ s the money funding nursing roles ?’ asks Ms Weaver . And Ms Brindley also points out that ARRS rates are based on a weighted average of the AfC pay scale , from which GPNs remain excluded : ‘ GPNs are then asked
‘ We ’ re supporting GPN development ’
Responding to the issues raised in this article , Liz Fenton , deputy chief nurse at HEE , says it is working with NHS England and NHS Improvement to ‘ support the development ’ of the ‘ critical ’ practice nurse workforce who provide ‘ hugely valuable services within local communities to people of all ages ’.
She highlights that GPNs have access to :
• A ‘ wide array ’ of modules on the free eLearning for health platform and a £ 1,000 personal continuing professional development budget over three years , per nurse , to support the development of their skills and knowledge .
• Advanced clinical practice and education programmes , such as non-medical prescribing .
Ms Fenton continues : ‘ We are working throughout our regions to increase the number of practice placements within primary care , as we know these services offer valuable learning opportunities and a positive experience encourages students to consider this as a career choice .
‘ We have recently invested in nurse educator roles in the regions , and student placements are supported by an education tariff which HEE is working to ensure is equitable across all settings .’ to support and contribute to the training and development of these individuals , who are paid more and have better terms and conditions of employment . How is that right ?’ However , Naomi Berry , a practice nurse in Bradford who qualified in 2019 , says sharing the workload between professions has freed up practice nurse time and could lead to leadership opportunities within the team . ‘ A bigger team is better ,’ she says . Ms Carrick agrees : ‘ I ’ m hoping this will have a huge impact on allowing nurses to spend more time with patients .’
Leaking talent On top of the issues around career progression , training and leadership explored above , nurses are facing a harsh reality as exposed by the Nursing in Practice survey : more work is being carried out by fewer nurses , many of whom who feel undervalued and unhappy about pay .
Perhaps it is unsurprising , then , that so many respondents revealed they are looking at retirement or quitting . For example , a practice nurse based in south-west England said they were thinking of retiring early because they felt ‘ exhausted ’ and it was ‘ an uphill struggle to keep going ’. Another nurse practitioner , based in the East Midlands , said they wanted to move to a nursing role outside of general practice because they could not see ‘ any improvements on the horizon ’ and did not feel their pay was reflective of their work or responsibilities . And a practice nurse in the West Midlands complained that practice nurses are ‘ not included ’ when AfC nurses are awarded a pay rise : ‘ We are always excluded and so feel undervalued .’
Ms Carrick ’ s own experiences echo these findings : ‘ A lot of excellent practice nurses have left for their mental health ,’ she says . And on top of the faster pace and complexity of the role , she also worries it has lost some of its appeal because of changes to working hours : ‘ It was essentially nine to five , Monday to Friday . That was one of the attractions , but we ’ re now open more often .’ She was speaking before NHS England announced on 1 March that practices in England ’ s PCNs would be required to open from 9am to 5pm on Saturdays from October .
Historically , when nurses leave , they take their experience with them . But Ms Hall , who also works as a lead nurse at NHS Devon CCG , praises a local legacy mentor scheme in its pilot year , which matches a practice nurse coming to the end of their career with a newly qualified nurse . In Devon , 62 % of nurses are over the age of 50 and were previously leaving without passing on their experience and knowledge . But now , the course is having a two-pronged effect : ‘ It ’ s supporting newly qualified nurses , but also aiding in the retention of nurses coming to the end of their career . Many of them are loving being a mentor and hopefully will stay on a bit longer ,’ she says .
In this way , the retention issue brings us back to the start of a nursing career . Ms Charlton , who is also a mentor for new GPNs and student nurses , is in agreement about the benefits of forging a link between potential joiners , new recruits and more experienced nurses before it ’ s too late .
She says : ‘ It ’ s a remarkable , rewarding job . Once we get student nurses in general practice , they say , “ I love it , I didn ’ t realise how much you do ”. Getting experienced nurses who might want to leave to link up with these younger nurses reinvigorates their passion for their job – because they realise how much they do know , and how good it is to pass on knowledge to the next generation .’ See page 8 for a full analysis of the findings from the Nursing in Practice survey
Within PCNs , I had to push the idea of a nurse being involved ... we ’ re nowhere near having the voice we deserve Sumeya Gulam