Supporting Practices nurses in the new world of General Practice

1. Supporting Practices nurses in the new world of General Practice Dr Marina Lupari Professional Lead for Primary & Community Care Royal College of Nursing

2. 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

3. Where are we now? • An alternative guide to the new NHS in England by KingsFund • https://www.youtube.com/watch?v=8CSp6HsQVtw

4. The news:

5. Primary care workforce/infrastructure:problems • 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.

6. Solutions • 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

7. Innovative Experiments: 1965: Duke University PA Program Charles Hudson Thelma Ingles

8. 5YFV/Vanguards – new care models

9. Nursing is integral to the 5YFV Prevention Empowering Patients Engaging Communities Local Leadership Aligned National Leadership Modern Workforce Use of Innovation Drive Efficiency Exploit Info. Revolution New Models of Care

10. 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

11. GP Nurses Competent, confident nurses for the 21st Century Practice Setting.

12. 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

13. Clinically significant questions focused on health policy issues : How do we decide who provides particular types of care at particular times and places?

14. “nurses…particularly effective at improvisation, invention….” NY VNA, circa 1900, VNA Coll.

15. 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

16. 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

17. 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

19. Limitations to PN progression • Scope of practice • Payment • Competition vs.. Collaboration • Nursing & Midwifery Council • Autonomy • Prescriptive authority

20. 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

21. Nursing contribution to strengthening Primary Care • 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

22. 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

23. What about the new NMC Code? • Revised Code comes into force from 31March 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

24. What is revalidation? • From 31 December 2015Revalidation 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 yearsat 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

25. 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 reflectionson feedback, CPD and/or the Codeand discuss these with another NMC registrant • Have an indemnityarrangement in place • Confirm your good health and character • Obtain confirmation from an appropriate third party that you have met the revalidation requirements

26. Revised Code: key areas of change

27. Current developments • Response to HEE Primary care workforce commission call for evidence • RCN/RCGP statement on principles for primary care • Launch of GPN Career Framework • Primary care themes within the RCN response to the Five Year Forward View • Primary care themes within the RCN response to the State of Caring Recommendations • CQC GPNurse inspection regime • Revision of GPN toolkit • Production of HCA toolkit

28. So change is on its way…? I’m all for progress— It’s change that I can’t stand… Mark Twain