7
JURGEN ZIEWE shortage of registered nurses , alongside increasing and complex patient needs , I ’ m not concerned the GPN role will be eroded – but it will inevitably change .
‘ ARRS threatens to dilute the GPN role ’ Others are more concerned . RCN UK professional lead for primary care Heather Randle , says she supports the scheme , but questions what the changes , mostly introduced without consultation , could ultimately mean for established nursing teams .
‘ From a GPN point of view , ARRS threatens to dilute the role . Patients may be getting a diabetic check by one person , a pharmacy review with another , but this is forgetting the unique role the practice nurse does so well . ‘ A GPN is like no other role in healthcare . You need general knowledge and skills in so many different areas . But ARRS is putting the role at risk ,’ Ms Randle warns .
‘ What has not been looked at is the value of the GPN role , and how to recruit to that role and keep those skills going . ARRS has been done to GPNs , not with them .
Sarah Hall , a steering committee member of the RCN GPN Forum , and a Queen ’ s Nurse , shares these concerns .
She says ‘ I do feel really strongly about the way these roles have been brought into general practice – that they are undermining the role of the general practice nurse .
‘ My worry is that people working in additional roles are taking on the roles of GPNs , and that general practice won ’ t need as many GPNs .’
ARRS may have expanded the general practice team , but it has made no difference to the shortage of GPNs . ‘ General practice nurses were not included in the ARRS , so the capacity of registered nurses could not be increased through this funded scheme ,’ comments Queen ’ s Nursing Institute chief executive Dr Crystal Oldman .
‘ Instead , some general practice nurses have found they are mentoring and teaching practitioners coming in under ARRS – an additional demand on their time .’
Ms Randle says some GPNs are being asked to supervise practitioners in ARRS roles , such as pharmacists , who often have ‘ better terms and conditions [ which ] can make GPNs feel undervalued and invisible ’. From a patient perspective , the new roles could be confusing , she suggests , and may disrupt the continuity that comes with being cared for and treated by a GPN .
‘ Put yourself in the patient ’ s position – rather than seeing their practice nurse , they may now have three different visits to different practitioners . For the patient , care must feel disjointed and frustrating .’
‘ Mixed impact ’ The ARRS scheme ’ s impact on GPNs to date seems to depend largely on the PCN ’ s approach . Dr Oldman says the QNI ’ s networks of general practice nurses report ‘ a mixed impact ’.
Ms Hall explains . ‘ One GPN I spoke to says their PCN has integrated the roles well , there is great teamworking , and they are using their specialist knowledge to support each other . However , another told me that additional roles staff were not embedded within their PCN , and these staff were finding it difficult to feel part of a team .’
On the positive side , Andrea Mann , a GPN and clinical director at Crossgates PCN and East Leeds Collaborative , says she has not heard of ‘ any negative feedback or resistance to working alongside the PCN clinical team ’.
Ms Mann explains that a ‘ conscious decision made at board level was to make sure our PCN team was working across the four practices ’. She adds : ‘ They are very much embedded within practice teams , and they spend time at each practice across the working week .
Nursing associates are seen as an asset , but one of the issues is the time that needs to be invested in their training Jenny Bostock
ARRS ROLES Tell us your experiences of how the new roles work . Visit our Facebook page at facebook . com / NursinginPracticeMagazine
‘ Whether it ’ s nursing roles or other allied health professionals , they have worked really well in the PCN , and there ’ s good communication and working relationships with GPNs and GPs at the practices .’
Jenny Bostock , a clinical director for Ramsgate PCN and an advanced nurse practitioner , says the ‘ unrelenting ’ workload in general practice means having new roles to support GPNs is ‘ a positive solution ’.
‘ A large proportion of GPNs are coming to retirement age and the ARRS roles are being seen as the solution to recruitment and bridging the gap ,’ she says .
‘ However , it is taking time to train the new roles and ensure they are competent in their clinical skills .’
Ms Bostock says clinical pharmacists at the PCN are starting to take on areas of chronic disease , which is relieving the workload of some GPNs who have historically managed all the chronic disease .
‘ This is particularly useful with smaller practices . Clinical pharmacists have a good background of drugs and can manage chronic diseases well .’
Physiotherapists have also attracted praise . North London-based ANP Saira Yeadally Khan says : ‘ They really help patients with musculoskeletal conditions and have definitely helped my workload .’
Shift to a medical model While nurses welcome clinical pharmacists ’ expert knowledge of medicines , there are concerns about them working to a medical model , rather than taking a holistic approach to patient care .
Bradford-based GPN Naomi Berry says her workload ‘ doubled ’ when clinical pharmacists first started carrying out medication reviews of her patients .
She explains : ‘ Their approach was very medical – they didn ’ t take a holistic approach in the same way as a practice nurse would .’ For instance , sometimes pharmacists did not identify the need for blood pressure checks or specific blood tests , creating the need for additional practice nurse appointments .’
Ms Berry says regular feedback to the pharmacists has improved the situation , ‘ but it would have been good to have sat down at the start , to talk through what I do as a practice nurse , and how they could alleviate some of the workload pressures when seeing patients ’.
Pharmacists may also not understand the patient ’ s needs beyond medication , Ms Randle adds . ‘ Sometimes , for example , an inhaler might be better for the patient ’ s symptoms , but they might not be able to afford it . It ’ s those nuances of general practice we ’ re losing .’
Nursing associates : ‘ an asset to practices ’ The new nursing associate role – introduced in England to bridge the gap between healthcare assistants and registered nurses – is also having an impact on general practice nursing . Some 6,874 were registered with the NMC as of March 2022 , and with the roles eligible for ARRS funding since 2020 , more nursing associates and trainees are coming into general practice .
Ms Bostock says nursing associates are seen as ‘ an asset to practices ’. She explains : ‘ They support the GPNs and take off the simple work , giving them time to deal with more complex patients .’
Trainee nursing associates are being trained by GPNs ‘ and are doing a great job as they can take bloods , blood pressures , measure height and weights , and perform simple dressings ’, she says . ‘ However , one of the issues is the time that needs to be invested in their training .’
Jenny Aston , an ANP for Granta Medical Practices in Cambridge , says uptake of nursing associates is