8 | Nursing in Practice | Summer 2022
their health in the wake of the pandemic , which is resulting in an ‘ escalation of demand ’. But while demand is growing , numbers of GPNs are falling , she says , with ‘ nursing colleagues taking early retirement or even ditching their permanent positions to do locum shifts in general practice ’.
GPNs have concerns about whether families are getting sufficient child health support . ‘ What I ’ m hearing from nurses is that they are still seeing problems around face-to-face contact with health visitors and school nurses ,’ says Ms Randle . She says this is putting ‘ more pressure ’ on practice nurses , who are being asked about issues that health visitors would normally address .
Parents have told Ms Berry that they have not seen health visitors in person , and she is often questioned about access to baby clinics . ‘ We ’ re doing as much as we can to try and offer as much support as we can , to answer parents ’ questions and provide relevant information , but it ’ s difficult ,’ she says .
Recognising the workload pressures facing health visitors , Ms Allen says she tries to support parents , giving them guidance and basic information on good nutrition , and , if necessary , referring them to a paediatrician . ‘ Health visitors have been getting in touch with us asking for help with tasks because they are particularly busy , so we ’ ve been stepping up to do what we can to help ,’ she says .
One way of helping to address the demanding workload is to educate parents , Ms Randle says . She reports seeing ‘ some good work with self-care ’, where GPNs are teaching parents how to deal with a high temperature or a child with vomiting and diarrhoea – ‘ the conditions people can treat themselves ’.
Ms Berry also points to a rise in ‘ major poverty ’ for many parents , as the cost-of-living crisis bites . She says : ‘ We are looking to find ways to deal with this , including providing preventive and holistic care , which is more important than ever .’
Peer support for GPNs is on the increase , ‘ but still needs a lot of work ’, Ms Randle believes . ‘ We should be giving every nurse in general practice supervision to reflect on their practice and to learn from it . And we should be making sure nurses are released from practices to do staff training .’ She says the Government ‘ should be looking at this issue to bring on the general practice workforce ’.
Workforce measures are vital to help GPNs cope with the growing need from families . Ministers need to ‘ look at other ways to subsidise training , or GPNs and ANPs are going to be harder to come by ’, argues Ms Allen .
Backlog of care for vulnerable children As for child immunisations , the picture in general practice is that MMR uptake has ‘ dropped quite a bit and we are seeing outbreaks of measles ’, says Ms Randle . This could be explained by a reluctance from parents to bring children to the surgery for fear of their catching Covid , or be down to of a lack of trust in vaccines generally , she suggests .
The UK Health Security Agency reports that coverage for the two doses of MMR vaccine in five-year-olds in England is currently at 85.5 %, well below the 95 % World Health Organization ’ s target needed to achieve and sustain measles elimination .
Sharon White , chief executive of the School and Public Health Nurses Association ( SAPHNA ), says that despite the adverse conditions , nurses remain ‘ absolutely invested in children ... doing what nurses do – rolling
Statistics
The Institute of Health Visiting describes the health visiting workforce as being at ‘ an all-time low ’.
• There were 6,278 health visitors in November 2021 , a decrease from 9,376 in November 2016 .
• NSPCC analysis of Public Health England data found that in 2021 , one in five babies in England did not receive their 12-month health visiting review , with more than 106,000 babies missing out . Since 2016 , there has been a 10 % decrease in the proportion of babies receiving this check .
The cost of living taking its toll on families
• Around 9 in 10 ( 87 %) adults reported an increase in their cost of living over the previous month in March 2022
• Millions of families are cutting back on food or missing meals altogether , according to data from The Food Foundation , which showed a sharp increase in children experiencing food insecurity , with 2.6 million under-18s living in households that do not have access to a healthy , affordable diet
Sources ONS . The rising cost of living and its impact on individuals in Great Britain : November 2021 to March 2022 . bit . ly / 3NVcO7e The Food Foundation , Food insecurity tracker , April 2022 . bit . ly / 3mnnNdT their sleeves up , knuckling down and getting on with it with grit and determination ’. But she says there is ‘ a lot of catching up to do ’ regarding immunisations .
Ms White suggests the drop in MMR uptake is down to the fact that , during the pandemic , children were not in schools , NHS services were stretched and there was also concern about presenting in clinical settings .
Denise Phillips , a matron at a south-east London NHS foundation trust and a former school nurse , is responsible for supporting school nurses . She says they are facing ‘ more challenges than ever before ’ in terms of the backlog of vulnerable children needing support , including those with safeguarding issues .
One school nurse in the south of England , who asked not to be named , highlights the detrimental effects of the cost-of-living crisis . ‘ We ’ re seeing more food poverty than ever before ’.
Ms Phillips says the attrition rate among school nurses has risen . ‘ We have had to look at our service and put in critical short-term staffing measures to enable it to function and for nurses to have more face-to-face contacts .’
School nursing is ‘ still suffering massive cuts – including from local authorities seeking to make cost savings – so the picture isn ’ t good in terms of meeting need ’, says Ms White .
Despite these difficulties , the school nursing community ‘ never fails to inspire me ’ she says . SAPHNA has compiled an online resource showcasing inspirational examples of good practice , which include innovative approaches to managing anxiety , immunisation campaigns and tips on feeding schoolchildren on a budget .
Mental health problems in families have been exacerbated by the pandemic . A rising number of children are experiencing delays in their development including language and speech issues , and there can be long waiting times for CAMHS services , she says .
To help address soaring demand , and address concerns over mental health issues among pupils , NHS mental health support teams are now in place in around 4,700 schools and colleges across the country , with 287 expert teams offering support to children experiencing anxiety , depression , and other common mental health issues , and plans for at least 200 more across England . But much more still needs to be done to put the wellbeing of children and babies ‘ back on the agenda ’, says Ms White .
‘ The Government needs to stop cutting the public health grant , and reinvest in school nursing .
‘ And it needs to reverse austerity – if children are hungry , they won ’ t attend school , they won ’ t learn , and our colleagues cannot even begin to address any of these other issues ,’ she stresses .
The clear message from nurses is they want the Government to take steps to safeguard services and tackle the workforce shortage in order to prevent the difficulties they face from escalating still further . Ms Berry urges ministers : ‘ Give us the support we need , back us up – show us you ’ re on our side .’
Until that happens , the current workload and staffing pressures mean it is more important than ever for school nurses , health visitors and general practice nurses to take care of themselves so they can keep doing their best for patients . As Ms White says : ‘ Self-care has never been more important .
‘ Nurses are exhausted and stressed , facing quite complex and really traumatic experiences . There ’ s no let-up ; you need to care for yourself , so you can continue to care for others .’