Supporting Practices nurses in the new world of General Practice
Dr Marina Lupari
Professional Lead for Primary & Community Care
Royal College of Nursing
Dramatic Changes in Health Care Aging population Growing diversity Global health care system Bio-medical advances New areas of knowledge, i.e.
genetics, environmental health
Where are we now?
3
An alternative guide to the new NHS in England by KingsFund
https://www.youtube.com/watch?v=8CSp6HsQVtw
The news:
ageing population and changing consumer expectations>increase in demand for GP appointments.
45 million more appointments every year compared to 5 years ago
The number of people unable to get an appointment has been rising and public satisfaction with access to GPs is falling.
People finding it too hard to see their GP and GPs are finding it harder to give the kind of personal care that is the hallmark of their profession.
Primary care workforce/infrastructure:problems
Increasing the primary and community care workforce by at least 10,000, including an estimated 5,000 more doctors working in general practice, as well as more practice nurses, district nurses, physicians’ associates and pharmacists
A new deal on infrastructure
BUT…a new deal on access with a seven-day NHS
Solutions
Innovative Experiments:
1965: Duke University PA Program
Charles HudsonThelma Ingles
5YFV/Vanguards – new care models
Prevention
Empowering Patients
Engaging
Communities
New Models of
Care
Local Leadershi
pAligned
National
Leadership
Modern Workforce
Exploit Info.
Revolution
Use of Innovation
Drive Efficiency
Nursing is integral to the 5YFV
What does it mean for Nursing?
Focusing on prevention
Empowering patients
Engaging communities
• Incentivise healthier individual behaviours
• Strengthen powers for Local Authorities
• Targeted prevention programmes – starting with diabetes
• Additional support people to get and stay in employment
• Create healthier workplaces – starting with the NHS
• Staff as role models
• Staff as expert in behaviour change
• Improve information: personal access to integrated records
• Invest in self- management
• Support patient choice
• Increase patient control including through Integrated Personal Commissioning (IPC)
• New relationships
• Sharing the leadership space with patients
• Support England’s 5.5m carers – particularly the vulnerable
• Supporting the development of new volunteering programmes
• Finding new ways to engage and commission the voluntary sector
• NHS reflecting local diversity as an employer
GP NursesCompetent, confident nurses for the 21st Century Practice Setting.
Making Room in the Clinic….Modern health care depends upon:
Nurses, physicians, and patients working together
finding common ground
putting patients first
knowing how to use the skills and knowledge of providers across time and place
Clinically significant questions focused on health policy issues :
How do we decide who provides particular types of care at particular times and places?
NY VNA, circa 1900, VNA Coll.
“nurses…particularly effective at improvisation, invention….”
What do PNs do?
“Patient Centered” Assessment Diagnosis Treatment Case Management/coordination of care/integration Continuity and secure transmission across the
health system Emotional support Access “Whole Person”…Family and Community focus
PN Managed Clinics
History of nurses managing health care independently and interdependently:
– In home during child birth and plagues– In wars caring for the soldiers – In public/community health during
epidemics
Some of the challenges for PNs• Care need is changing more quickly than workforce
development producing huge capacity and capability pressures
• Models of practice are very variable;• Availability of specialist practice and leadership education
and training is decreasing;• Profile of DN & PN is low• Young people are not given adequate careers advice • Undergraduate student nurses can’t access placements
easily • Qualified nurses often use DN & PN post as a default
position • Historical education commissioning methods• Ageing workforce• Indemnity
Limitations to PN progression
Scope of practice Payment Competition vs..
Collaboration Nursing & Midwifery
Council Autonomy Prescriptive authority
Some of the challenges for PNs• Care need is changing more quickly than workforce
development producing huge capacity and capability pressures
• Models of practice are very variable;• Availability of specialist practice and leadership education
and training is decreasing;• Profile of DN & PN is low• Young people are not given adequate careers advice • Undergraduate student nurses can’t access placements
easily • Qualified nurses often use DN & PN post as a default
position • Historical education commissioning methods• Ageing workforce• Indemnity
Transforming Nursing for Community and Primary Care
Revalidation for nurses Accountable clinician Compassion in Practice/ 6Cs Supporting New Care Models CQC inspection of general practice Workforce review
All the above programmes have or will have a focus on community and primary care nursing
Nursing contribution to strengthening Primary Care
Focus on developing more general practice, district and community nurses to:•Play an enhanced role in the community•Enable healthy lives and managing self- care•Enable whole-person coordinated care
Addition of a community care field to encourage more nurses to see specialised community care as a future career - field could include district nurses, GP practice nurses, health visitors and school nurses
Develop more practice placements in primary care
What about the new NMC Code?
Revised Code comes into force from 31 March 2015
Contains the professional standards that all registered nurses and midwives must uphold
The Code will be central to revalidation process as a focus for professional reflection
What is revalidation?
• From 31 December 2015 Revalidation will be the process by which all registered nurses and midwives will demonstrate to the NMC that they continue to remain fit to practice
• Revalidation will take place every three years at the point of renewal of registration and will replace the existing Prep standards
• To revalidate, registrants must declare that they have met a number of requirements over the three year period
• Every year the NMC will select a sample of nurses and midwives to audit
What are the revalidation requirements?
Minimum 450 hours practice over three years Minimum 40 hours of CPD, 20 of which ‘participatory’ Obtain at least 5 pieces of practice-related feedback Record at least 5 written reflections on feedback, CPD
and/or the Code and discuss these with another NMC registrant
Have an indemnity arrangement in place Confirm your good health and character Obtain confirmation from an appropriate third party
that you have met the revalidation requirements
Revised Code: key areas of change
Current developments
Response to HEE Primary care workforce commission call for evidenceRCN/RCGP statement on principles for primary careLaunch of GPN Career Framework Primary care themes within the RCN response to the Five Year Forward ViewPrimary care themes within the RCN response to the State of Caring RecommendationsCQC GPNurse inspection regimeRevision of GPN toolkitProduction of HCA toolkit
So change is on its way…?
I’m all for progress—
It’s change that I can’t stand…
Mark Twain