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Health Education EnglandThe General Practice NursingWorkforce Development PlanHealth Education EnglandThe General Practice NursingWorkforce Development PlanExecutive SummaryThe highly-skilled general practice nursingworkforce of today provides an essential highstandard of care to their local populations. Theyhave earned their place as both valued andvaluable members of primary care teams. Thegeneral practice nursing team as described in theHEE District Nurse and General Practice NursingEducation and Career Framework7, includeshealthcare assistants (HCAs) at levels 1-4, GPNsat levels 5-6, senior GPNs at level 7 and advancednurse practitioners at level 8. GPNs have becomeclinical leaders in their own right, managing theirown caseloads particularly in the engine room ofincreasingly complex multi-morbidity management,including extended autonomous roles that aredifficult to replace. They offer a large amountof both first contact and continuing care forthe population, managing long-term conditionslike chronic heart disease, diabetes and asthma;treating acute illness and supporting vulnerablegroups like children, the elderly and those withmental health problems, learning disabilities ordementia. They strive to keep them healthy, safeand wherever possible out of hospital. They are theambassadors of health promotion and supportingpatients in self-management. The healthcaresupport workforce is being increasingly recognisedfor their growing contribution in general practiceby supporting GPNs and taking on broader clinicalroles with the potential for further development.The last 30 years has seen a huge change in therole of GPNs and HCAs in a general practicesetting. We now have a combined GPN, AdvancedNurse Practitioner (ANP) and GP healthcaresupport workforce of over 30,0008 (headcount)working in general practice in England. Today’sageing population and the increasing prevalenceof multiple comorbidities, combined with thedrive to shift patient care from hospitals to thecommunity, have prompted moves to expand therole of GPNs and HCAs in primary care. While itmakes sense to bring services closer to patients,there have been few coherent strategies forincreasing this workforce at scale. As existingexperienced GPNs increasingly retire, GPs arestruggling to fill the vacancies with nurses ofsimilar experience. Furthermore, growing financialpressures have reduced GPs’ capacity to grow theirclinical and administrative staff workforce and thishas affected their ability to keep pace with thegrowth in patient demand. The majority of GPNscurrently in post joined general practice from otherhospital and community posts, embarking on a“second career” often with only ad-hoc in-houseorientation and training. This does not comparefavourably with the nurse career structure offeredby larger organisations. Furthermore, generalpractice nursing has rarely been marketed as afirst destination career. Evidence suggests generalpractice is seen to be a “risky choice” for a newlyqualified nurse9.This report is a positive call to action with clearand unambiguous recommendations to improvethe recruitment, retention and return of generalpractice nurses. This directly responds to boththe current and anticipated workforce challengesand acknowledges the need for timely successionplanning and organisational development. Withthis in place it will be possible to replace at scalethe large current cohort of GPNs approachingretirement10 who will take with them their expertknowledge, experience and skills, especially asthe experts in chronic disease management.This in turn will help surgeries flourish not onlymaintaining but improving the quality, range andsustainability of service provision our patientsexpect and deserve. It will also serve to reduceunwarranted variation in service provision.To achieve the goal of right person, right place,right time with greater capacity in general practicesignificant growth of the healthcare supportworkforce at all levels is required. There are greatopportunities now to embrace and develop at pacehealthcare support careers to ensure the wholeclinical team functions to its maximum.6The Primary Care Workforce Commission11suggested methods to enhance general practicenursing recruitment including better managementand the development of leadership skills with clearcareer progression opportunities. Reliable, up-todate careers information is needed. Identifyingexisting and required competencies and howstaff can develop their skills to progress withinan organisation is an important first step to avoidthem seeking career aspirations outside primarycare. In the case of general practice nursing, theHEE District Nurse and General Practice NursingEducation and Career Framework12, RCGP GeneralPractice Foundation, General Practice NurseCompetencies13, RCGP General Practice FoundationAdvanced Nurse Practitioner Competencies14 andRoyal College of General Practitioners HealthcareAssistants (General Practice) CompetencyFramework15 provide this, outlining the skills andeducation required at each level of general practicenursing. It helps staff not only understand whatis expected of them at any point along the careerpathway, but also encourages the aspiring nursewith development opportunities and informs careerprogression programmes.This workforce plan covers four main areas: Entry into general practice nursing (preregistration) – how we improve the visibility andraise the profile of general practice nursing asa first career choice, and in particular increasethe number of training placements in generalpractice for pre-registration nursing students. Establishing the role of the general practicenurse - the early years (post-registration) - howto ensure suitable training and practice supportfor all new entrants to GP nursing to produceeffective GPNs with the appropriate attitudesand skills. Enhancing the GPN role – how to maximisethe professional development of GPNs throughaccessible, fit-for-purpose training and clearlydefined career progression making GPN careersattractive at all levels7

Health Education EnglandThe General Practice NursingWorkforce Development Plan Expanding the healthcare support workforce –how to increase the popularity of the healthcareassistant role, grow numbers at pace whileensuring high-quality, standardised, accessibletraining that leads to appropriate careerpathways.Many of our recommendations are not difficultto achieve and we recognise that many of ourrecommendations may already be happening insome areas, for example, raising awareness ofgeneral practice nursing. Others will require moretime, effort and collaboration working acrossorganisational boundaries, for example, to increasethe number of new entrants and mentors. Careerprogression and development for GPNs mustbe improved. We also need to offer supportedtraining opportunities for the healthcare supportworkforce to further develop their clinical skillbase. While new roles to general practice e.g.physician associates, clinical pharmacists, GP/medical assistants, care navigators and nursingassociates will certainly be able to support generalpractice in the future, delivery at scale will taketime. The HCA role already has clear competenciesset out in the Royal College of General Practitioners(2015) Healthcare Assistants (General Practice)Competency Framework16 and the HEE DistrictNursing and General Practice Nursing Educationand Career Framework17 .Much of the responsibility for tackling the problemslies with individual general practices, GP federationsand the emerging new care models includingmulti-specialty community providers as the leademployers. However, Clinical Commissioning Groups(CCGs) and the emerging HEE national traininghub network, known in some areas as CommunityEducational Provider Networks (CEPNs) or AdvancedTraining Practices (ATPs), will have a crucial partto play. Training hubs are being developed by HEEas part of the General Practice Forward View18 toencourage local expertise and educational supportto help general practice respond to the challenges.We would also call on those delivering the newSTPs to take account of how they can support theseefforts. With their remit to ensure health servicesmeet the needs of local populations, it is importantthat they acknowledge and support the generalpractice nursing workforce initiatives we set out inthis document.The making, shaping and supporting of effectivelocal general practice workforces as a top priorityand an achievable goal across the country will becritical in addressing the unwarranted variations incare and outcomes we currently see.Summary of RecommendationsSection 1Recommendation 1: Raise the profile of general practice nursing careers.A nationally co-ordinated campaign to increase the understanding of the value given to the generalpractice nursing role across all healthcare organisations, schools, colleges and the general public.Recommendation 2: Increase the number of pre-registration nurse clinical placements in generalpractice.Recommendation 3: Introduce quality assurance of the learning environment in general practicefor pre-registration nurses. The HEE Quality Framework and regulatory processes must be adoptedacross England.Section 2Recommendation 4: Increase the uptake of general practice nursing as first destinationemployment for newly-qualified nurses. Review and develop recruitment schemes and supportmechanisms to specifically attract newly-qualified nurses into general practice.Recommendation 5: All new entrant nurses and support staff to general practice have accessto an approved employer-led induction programme. This must be tailored to meet local need,accompanied by a personalised continuing professional development (CPD) plan.Recommendation 6: All new nurses to general practice must receive a standardised andaccredited competency based preceptorship programme to equip them for their general practicenursing role.Such preceptorship programmes should reflect the HEE Preceptorships Standards and the HEEPreceptorship Outcomes Framework and be mapped to the Royal College of General PractitionersGeneral Practice Foundation, RCN (2012 updated 2015) General Practice Nurse Competenciesand the NMC Code.Recommendation 7: GPN educator roles should be developed to cover all CCG areas. Their roleshould include promoting mentor training for all GPNs including sign off mentor roles.Joint higher education and primary care initiatives to further develop mentorship programmesand include registration on local mentor registers. This is critical to growing the capacity of nurseeducation in a general practice setting.89

Section 3Section 4Recommendation 8: All GPNs should have access to accredited training to equip them foreach level of their role. Training should be aligned with the RCGP General Practice Foundation,General Practice Nurse Competencies, HEE District Nursing & General Practice NursingServices Education & Career Framework (2015), supported by the HEE National EducationCommissioning Specification and the QNI/QNIS Voluntary Standards for General Practice NurseEducation and Practice.Recommendation 14: Increase the number of HCAs in general practice to include wideningparticipation schemes that encourage use of the HCA apprenticeship route and support theemerging role of the nursing associate.GP leaders and commissioners should work with HEE to achieve a coalition of support for HEEtaking on this role with appropriate resourcing.Recommendation 16: All education and training for HCAs in general practice must bealigned to the Royal College of General Pra

21st century. My thanks go to everyone who has worked so hard in pulling this general practice nursing development plan together. Health Education England, NHS England, the Queen's Nursing Institute (QNI), the Royal College of General Practitioners (RCGP), the Royal College of Nursing (RCN) with the many contributions, discussions