Nursing in Practice March/April 2019 (issue 107) - Page 16

16 COVER STORY Newly qualifi ed nurses to receive fellowship if entering general practice What the plan says Newly qualifi ed nurses entering general practice will be offered a two-year fellowship – a scheme suggested by the recent GP partnership review. NHS England says this will offer ‘a secure contract of employment alongside a portfolio role tailored to the aims of the individual and the needs of local primary care’. According to the plan, the move will enable newly qualifi ed nurses to ‘consider primary care as a fi rst destination role’. Will it help? The fellowship could help attract newly qualifi ed nurses. Many younger, recently qualifi ed nurses report that they get turned away from general practice posts because of a lack of experience, and instead go to secondary care. Opening spaces in general practice for these nurses will take advantage of their initial enthusiasm upon qualifying and give them a structured environment in which to learn. But the scheme’s effectiveness will depend on good mentorship, clear terms and conditions for the period after the fellowship, and details of funding. GPs will not necessarily be in a position to fi nance this extra resource. Nurses will also need a considered plan for career progression so that they will know whether the move offers the potential for further career opportunities. Also, the proposal also might alienate established nurses in secondary care who are keen to move to general practice. The professionals’ views Rachel Viggars, mentor for nursing students at Keele University, specialist nurse practitioner and clinical nurse lead at Ashley Surgery in Shropshire: ‘This is a positive step. It provides the structure to ensure professionalism and Expanding ‘credentialing’ to cover more areas What the plan says NHS England says it will ‘expand multiprofessional credentialing to enable clinicians to develop new capabilities formally recognised in specifi c areas of competence’. This will allow clinicians to ‘shift or expand their scope of practice to other areas more easily, creating a more adaptable workforce’, it says. With partners, NHS England has developed several credentials, such as the Royal College of Nursing (RCN) advanced-level nurse practitioner credentialing scheme. NHS England plans to ‘accelerate development of credentials for mental health, cardiovascular disease, ageing population, preventing harm and cancer, with the intention of publishing standards in 2020’. Will it help? Credentialing is a means of addressing workforce shortages and fi lling gaps in care. It is also an opportunity for nurses to practise at advanced level and have their additional skills formally recognised. March/April 2019 standardisation of training, but it requires good, positive mentorship and supportive environments. The employment after the fellowship will also need proper terms and conditions if we are to retain this developing workforce. ‘Thought must be given to the career progression for these nurses after this fellowship. ‘One major challenge is this: many practices are unable to offer full-time posts, which are needed for new staff to achieve and learn. Newly qualifi ed nurses are looking for full-time posts, preceptorship and a career pathway. ‘Targeting younger nurses is fair. Sadly, students are still being told by some tutors and secondary care staff that primary care is not a fi rst-destination career and they shouldn’t consider it until the end of their working life. Young newly qualifi ed nurses are safe as long as they have a mentor, educational support and support from the employing practice. But there might be problems if they are not supported.’ Alexandra Tanner, a third-year nurse studying at Keele University: ‘I had a 12-week practice nursing placement during my degree, but despite that, a keen interest in primary care and good knowledge of long-term conditions, I have not been able to get a practice nurse post, and have now accepted a district nursing post. The two-year fellowship sounds positive, but does it allow for continuing development? As with any other role, training will always be required. An “experienced nurse” who has worked in A&E for 20 years may not have the knowledge of long-term conditions or travel health.’ Dr David Turner, GP partner in Hertfordshire: ‘It raises more questions than answers. Does the two-year fellowship mean they are coming to us as practice nurses, or is the practice going to train them? Who is paying for this? It all depends what skills they come in with. If they are a newly qualifi ed nurse with a lot of training and will sit in with the practice nurse and learn and contribute, then that’s fi ne. But if they come with no practical skills, the practice nurse has to take the time to train them and we would need funding for that. It would also slow down our current practice nurses. ‘Specifi c training courses would be required for these nurses. Some general practice nursing skills need certifi ed training, which will be expensive.’ NHS England’s aim to widen the remit of credentialing by publishing standards on areas like mental health and cancer increases the potential for practice nurses to broaden their skills. The RCN’s credentialing scheme is still developing, but the College says that in the future, some GP practices might include a particular credential, such as the advanced- level nurse practitioner award, as a requirement for certain posts. But while the process will enable nurses to better respond to the complexities of nursing care, it does not mean better pay. Formal recognition does not necessarily equate to a bigger salary, particularly in GP surgeries. The professionals’ views RCN head of nursing practice Wendy Preston: ‘Advanced nurse practitioners work autonomously, and the expansion of this valuable workforce has also meant that medical professionals can focus on more complex aspects of care. The skills of practice nurses are constantly expanding to ensure competent clinical responses to the increasing complexity of nursing care. ‘Some areas of practice now include palliative care reviews as well as managing long-term conditions like diabetes and asthma. In some cases, these nurses are the clinical lead, which was a role historically undertaken by doctors.’ This is a positive step. It provides a useful structure for training Rachel Viggars Skills of practice nurses are expanding to ensure competent responses to complex care