For years, nurses have been an important part of delivering care in general practice. And with current policy increasing the shift of care from hospital to general practice, nursing provision will only become more important.
However, at the same time, the skill mix within practices now often includes Health Care Assistants (level 2 – 4), Practice Nurses (5 – 7), Advanced Nurse Practitioners (7 – 8) and Nurse Partners (level 9), making it harder for practices to first of all work out the best staffing mix for their needs and then to ensure the potential of practice nurses (PNs) is maximised. It’s a topic that has been addressed on the forum recently, where a practice manager highlighted the light workload of one of their nurses – and what can be done to ensure they are working most efficiently.
Integral to the team… or not?
Talking to practice managers, it seems that one of the crucial aspects to get right with nurses is making sure they fit into the wider practice team and overall staffing levels. One comment quite rightly said: “I think I would just look at how the PN’s duties are fitting into the wider team. For example, do you have ANP’s, are they being used appropriately? Are you ensuring the GP’s aren’t doing all the chronic disease management?
“These are just a couple of quick examples, but if your nurse is relatively quiet every day and everyone else is being used appropriately then you have an overstaffing issue. I have 1.6 FTE nurses for our 6,000 population and they are always fully booked by the afternoon before, except for a couple of 10 minute slots we hold back for urgent bloods/ECG’s/dressings or other things that often crop up on the day and it is rare these aren’t used as well.”
The point here is that PNs should be utilised to the full, so you need to have a total understanding of their capacity and, if there’s room, look at the jobs they can pick up. Is there space to pick up chronic disease management? Could they specialise in diabetes management or respiratory management so they do all the routine care and the GP just prescribes?
Another comment on the forum pointed out the changing nature of practice staffing. “We’ve moved a lot of work to our enlarged HCA team and additionally, since the problems with indemnity levels, other work has moved up to our ANP so we are now finding that the role of the practice nurse is shrinking,” it read. “They are running nurse-led chronic disease clinics but hypertension reviews and some annual vascular checks are carried out by an HCA (pre-diabetes/IFG type reviews). We also have an HCA working alongside a PN during diabetes clinics to cut down the length of time they see the practice nurse because the HCA does a lot of the routine checks first.”
That practice’s HCAs are also taking on duties such as dressings and adult immunisations, meaning they are seriously thinking of not replacing one 30-hour nurse who seems likely to leave in the near future, despite a rising practice population.
However many nurses you have in your practice, their time needs to be filled, which can be sorted out by being proactive. Inviting patients for health checks or promoting travel clinics are two examples – and initiatives like this can earn additional income for the practice and score brownie points from the CQC.
It could also pay to consider further training and development to meet the needs of the business as a whole – and help PNs to use more of their time. It’s worth bearing in mind here that GPs get 10-minutes with patients. Nurses can spend longer with people, so ask who can be signposted to nurses instead of GPs. Are there any patients who would benefit from a longer chat – and feel more engaged as a result?
Talking of signposting, many practices that we spoke to are benefitting from giving nursing staff the responsibility for actively highlighting alternative sources of health and wellbeing information and places to turn for support, either online or in the form of leaflets, charity info and so on.
Another PM told us that they solved the issue of their nursing team being underused by involving them in triage. The team of three PNs at one surgery in the Midlands were used on a rota basis to provide triage and refer patients onto doctors, a nurse, or to local pharmacists – a move that has reduced GP appointments significantly. It was a welcome move given the practice has been struggling to recruit a new GP for the best part of a year.
Other practices are using nurses to deal with medication reviews where GP consultations aren’t required.
However you decide to use your nursing team, effective teamwork is underpinned by effective two-way communication. If the nurse is to play an active role within the team, she/he will need to be well informed, have effective lines of communication within the practice and professional networks which extend beyond it.
Nurses (of all levels) remain an integral part of the practice staff mix. By identifying capacity and any skills opportunities they offer – and matching practice needs, roles and responsibilities accordingly – they can be maximised to their full.
How do you maximise the benefits from your practice nurses? Let us know by commenting below or take it to the Practice Index Forum.