In previous posts on the Practice Index blog we’ve looked at GP to patient ratios and staff to patient ratios. One area we’ve only touched on, however, is practice nurse to patient ratio, which is why in this post we’ll look to see if there’s a way of accurately calculating how many nurses you need.

Delving into the stats

So what do the stats say? The results of research carried out by The Health & Social Care Information Centre (HSCIC) in 2013, revealed that there is one full-time equivalent (FTE) nurse per 3,793 registered patients, which is a 1.5% increase in the number of patients versus the year before.

Just to confuse matters, an NHS practice management  study discovered that there are 0.45 FTE nursing staff per 1,000 patients (so one FTE nurse will look after 2,222 patients) – a number that is wildly different to the HSCIC figure.

• HSCIC: 1 FTE practice nurse per 3,793 patients
• NHS Practice Management Network: 1 FTE practice nurse per 2,222 patients

With more than a thousand patients difference between those surveys, should we therefore be looking at a different method of working out how many practice nurses are required in each surgery? Well, another way to look at the numbers is to compare the volume of practice nurses to GPs. A 2014 study by the Centre for Workforce Intelligence found that there were approximately 2.5 GPs for every practice nurse.

Muddying the waters

Talking to practice managers, it seems many of you work to a different stat; an approximation of 10 hours per thousand patients. You also point out that this number is totally flexible and needs to be varied according to population age, levels of deprivation and, of course the duties to be carried out by nurses.

Then, to confuse matters further, many practices are now looking to recruit healthcare assistants (HCAs) as they can take on many of the practice nurse duties at a lower cost. One practice told us that as, their practice list grew, they moved from two practice nurses covering a list of 6,000 to one practice nurse and two HCAs for a list of over 7,000.

When you consider that – according to recent salary surveys, HCAs command a salary approximately 40% less than a senior practice nurse – it’s no surprise that practices are looking to HCAs as an alternative. The HCAs are being trained to take on duties such as new patient checks, ear syringing, diabetic clinics, phlebotomy, ECGs and diet programme measurements, to name just a few.

A practice by practice decision

What the above tells us is that there’s pretty much no way of accurately benchmarking practice nurse to patient ratios across the UK. It really does vary from area to area and practice to practice according to the many variables at play.

What we do know, however, is that practice nurses are playing an increasingly important role in primary care as they become more skilled and deliver services previously performed by GPs. Indeed, 1,688 more practice nurses were employed by GPs in 2014 than ten years earlier, according to NHS Confederation stats published last week. When it comes to what that means in terms of per patient ratio, your guess is as good as ours!