Transition to
General
Practice
Nursing
Contents
Section A - Thinking about
working in primary care
Chapter 1 - What is General Practice
Nursing?
Chapter 2 - Making the transition
from hospital to primary care
Section B - Working in
General Practice
Chapter 3 - Working safely
Chapter 4 - Patient focus
Chapter 5 - Mid point reflection and
progress check on identified skills
development
Chapter 6 - Team working and
working with other professionals
Chapter 7 - Working with vulnerable
groups
Chapter 8 - Carer support
Section C - The future -
personal and professional
development
Chapter 9 - The policy context and
keeping up to date
Chapter 10 - Developing your career
in General Practice Nursing
,Section A - Thinking about working in primary
care
Chapter 1 - What is General Practice Nursing?
Introduction
The aim of this Chapter is to:
• Provide you with a brief overview of the history of General Practice
Nursing in the UK.
• Consider how some of the perceptions of General Practice Nursing
reflect the historic development of the role
• Outline the different roles and responsibilities of professionals in
the primary care setting
• Consider what skills you may need to work in the primary care
setting
Historical Perspectives
General Practice Nursing is a rapidly expanding speciality in nursing,
reflecting the shift in health care delivery from secondary to primary
care over the last two decades. Initially nurses were said to be attracted
to working within General Practice because of the regular hours and
flexibility offered because it tended not to involve shift work. Increasingly
it is because of the ability to work with individuals and families and to
take on a variety of roles and responsibilities.
Following the formation of the NHS in 1948, General Practitioners were
appointed as independent contractors and ‘gatekeepers’ of access
to health care. They have been responsible for delivering primary and
personal medical care to all those patients registered with them ever
since. It was not until 1966 that the first contract between General
Practitioners (GPs) and the National Health Service (NHS) was drawn
up and funding for ancillary staff, including nurses, was made available.
In the very early days nurses were generally employed to work in
treatment rooms, carrying out basic nursing care tasks such as weighing
patients, testing urine, taking specimens, doing dressings and giving
injections and observations such as temperature and pulse (Cartwright
and Scott 1961).
The limited range of duties of the General Practice Nurse (GPN) at this
time would have been unlikely to exceed the competencies expected of
any registered general nurse. This perception, that GPNs were unlikely
to require further post registration training or education to fulfil the role,
generally persisted up until the late 1980s. With subsequent changes
to the contracts that GPs have held with the NHS to provide General
Medical Services, both in 1990 and 2004, a greater emphasis has been
put on the role of GPNs in the management of long term conditions
(LTCs) such as diabetes, asthma and chronic obstructive pulmonary
disease and in health promotion. This has resulted in the requirement
for specific additional training for nurses working in General Practice.
The public attitude towards GPNs may reflect traditional attitudes
towards community nurses such as District Nurses due to the nature
of the care that they perform. Community nurses have traditionally had
to be creative in the way in which they practice and deliver care in
the home setting. They are renowned for being able to ‘think on their
,‘This perception that GPNs were unlikely to require further post
registration training or education generally persisted to the 1980s.’
feet’: to adapt to situations and be resourceful in Definition of a General Practice Nurse
unpredictable surrounding and situations QNI (2008). General Practice Nurses work as part of a Multi-
Similarly GPNs have responded to a rapid expansion Disciplinary Team (MDT) within GP surgeries and
in their role by developing skills, gaining knowledge assess, screen and treat patients of all ages. In addition
and maintaining informal networks to disseminate to providing traditional aspects of nursing care such
good practice. The Royal College of Nursing as wound care, immunisations and administration
(RCN) practice nurse forum lobbied for specialist of medicines, they run clinics for patients with Long
practitioner recognition from the United Kingdom Term Conditions such as asthma, heart disease and
Central Council (UKCC) and this was achieved in diabetes. They also offer health promotion advice in
1994 (UKCC 1994); however this did not result in a areas such as contraception, weight loss, smoking
recognised qualification. cessation and travel immunisations.
In addition to their role in the management of Role of general practice nurse
LTCs and in the treatment room, nurses in general
practice have developed skills in the management of
patients with undifferentiated diagnoses and those PATIENT FOCUS
requiring unscheduled or urgent care. This has led to • Therapeutic relationships
• Patient advocate
the development of Advanced Practice Nurses and • Carers support
Advanced Nurse Practitioners reflecting the diversity MANAGEMENT • Self-management COLLABORATIVE
• Evaluation and review • Inter-professional working
of opportunities available. The DH Advanced Practice • Organisational skills • Complex care co-ordinator
• Caseload
Position Statement (2010) outlines the key element • Care management
•
•
Referral
Written and verbal skills
of Advanced Practice which include prescribing and •
•
Emotional labour
Resources
• Technology
referral. • Business acumen
General SKILLS
www.gov.uk/government/uploads/system/uploads/ EDUCATION & KNOWLEDGE Practice • Holistic assessment
attachment_data/file/215935/dh_121738.pdf • Graduate/Masters level Nurse • Clinical decision making
workforce • Clinical skills
• National and local policy • Communication
The introduction of Health Care Assistants (HCA) • Needs assessment • Curative
• Maintenance
to the Multidisciplinary Team (MDT) within general • Strategy
• Palliative
• Evidence-based practice
practice has contributed to this diversification. The role • LTCs
LEADERSHIP
• Role identity
of the HCA in General Practice tends to involve tasks • Health promotion/
improvement • Team Leader/Staff Manage-
such as simple dressings and the administration of ment
• Mentor
injections under Patient Group Directives, but is still • Visionary
relatively new and varies from practice to practice. • Autonomy
Figure 1. Created by Sharon Aldridge-
Bent (2012)
The Shape of Caring review (2015) chaired by Lord
Willis outlines its intention to improve the capabilities
of Health and Social Care Assistants and for Health The Future
Education England (HEE) to promote structured The Health and Social Care Act (2012) primary care
career development for these increasingly important saw the introduction of Clinical Commissioning
members of the workforce. The introduction of Groups led by GPs responsible for the commissioning
the Care Certificate to be completed by all new and delivery of health care. As a result many GP
HCAs during their induction is the first step. The practices are working closely together to redesign
Care Certificate is a first level introduction to the primary care services and consider how the MDT
fundamentals of care and consists of 15 standards might work in different ways.
that are assessed ‘in house’ during the first 12 weeks
of employment. ‘The Five Year Forward View’ (2014) stresses the
need to change the way in which health care is
Below are links to the Shape of Caring Review and to delivered and suggests ways in which health and
further information on the Care Certificate. social care organisations might change. As a result
it is predicted that General Practice Nurses’ and
• http://hee.nhs.uk/wp-content/blogs.dir/321/ community nurses’ roles will continue to change in
files/2015/03/2348-Shape-of-caring-review- response to the demands and challenges presented
FINAL.pdf by an ageing population with complex physical and
mental health needs.
• www.skillsforcare.org .uk/St andards/Care-
Certificate/Care-Certificate.aspx ‘Transition to General Practice Nursing’ - Chapter 1 - p2
, It is likely however that nursing in general practice will continue to offer
a diverse range of career options.
Different roles in the community
General Practice Nurses work with a wide range of health and social
care professionals. Trying to identify and establish all the different roles
will seem quite daunting to begin with. Here is a brief overview of the
roles to get you started:
The multi-disciplinary team
Community
Staff Nurse District
Community
Mental Health Nurse
Nurse
Health
SaLT Visitor
School
Physio- General Nurse
therapists
Practice
Nurse
Occupa-
tional Community
Therapists Matron
GPs Nurse
Community Specialist
Learning
Children’s Disability
Nurses
General Practitioners (GPs) - provide a complete spectrum of
care within the local community: dealing with problems that often
combine physical, psychological and social components. Most GPs are
independent contractors to the NHS. This independence means that in
most cases, they are responsible for providing adequate premises from
which to practice and for employing their own staff.
District Nurses - are qualified and registered nurses who undertake
further training and education to become specialist community
practitioners. They visit people in their own homes or in residential care
homes, providing care for patients and supporting family members. As
well providing direct patient care, district nurses also have a teaching
role, working with patients to enable them to care for themselves or
with family members, teaching them how to give care to their relatives.
Health Visitors- also known as a Specialist Community Public Health
Nurse (SCPHN) - Health Visitors work with families with children under
the age of 5 years. They support families and children in issues such as
growth and development, post natal depression, breast feeding and
weaning, domestic violence and bereavement. They also play a role in
safeguarding and protecting children from harm.
School Nurses - also known as a Specialist Community Public Health
Nurse - (SCPHN). School nurses work primarily with children in the
General
Practice
Nursing
Contents
Section A - Thinking about
working in primary care
Chapter 1 - What is General Practice
Nursing?
Chapter 2 - Making the transition
from hospital to primary care
Section B - Working in
General Practice
Chapter 3 - Working safely
Chapter 4 - Patient focus
Chapter 5 - Mid point reflection and
progress check on identified skills
development
Chapter 6 - Team working and
working with other professionals
Chapter 7 - Working with vulnerable
groups
Chapter 8 - Carer support
Section C - The future -
personal and professional
development
Chapter 9 - The policy context and
keeping up to date
Chapter 10 - Developing your career
in General Practice Nursing
,Section A - Thinking about working in primary
care
Chapter 1 - What is General Practice Nursing?
Introduction
The aim of this Chapter is to:
• Provide you with a brief overview of the history of General Practice
Nursing in the UK.
• Consider how some of the perceptions of General Practice Nursing
reflect the historic development of the role
• Outline the different roles and responsibilities of professionals in
the primary care setting
• Consider what skills you may need to work in the primary care
setting
Historical Perspectives
General Practice Nursing is a rapidly expanding speciality in nursing,
reflecting the shift in health care delivery from secondary to primary
care over the last two decades. Initially nurses were said to be attracted
to working within General Practice because of the regular hours and
flexibility offered because it tended not to involve shift work. Increasingly
it is because of the ability to work with individuals and families and to
take on a variety of roles and responsibilities.
Following the formation of the NHS in 1948, General Practitioners were
appointed as independent contractors and ‘gatekeepers’ of access
to health care. They have been responsible for delivering primary and
personal medical care to all those patients registered with them ever
since. It was not until 1966 that the first contract between General
Practitioners (GPs) and the National Health Service (NHS) was drawn
up and funding for ancillary staff, including nurses, was made available.
In the very early days nurses were generally employed to work in
treatment rooms, carrying out basic nursing care tasks such as weighing
patients, testing urine, taking specimens, doing dressings and giving
injections and observations such as temperature and pulse (Cartwright
and Scott 1961).
The limited range of duties of the General Practice Nurse (GPN) at this
time would have been unlikely to exceed the competencies expected of
any registered general nurse. This perception, that GPNs were unlikely
to require further post registration training or education to fulfil the role,
generally persisted up until the late 1980s. With subsequent changes
to the contracts that GPs have held with the NHS to provide General
Medical Services, both in 1990 and 2004, a greater emphasis has been
put on the role of GPNs in the management of long term conditions
(LTCs) such as diabetes, asthma and chronic obstructive pulmonary
disease and in health promotion. This has resulted in the requirement
for specific additional training for nurses working in General Practice.
The public attitude towards GPNs may reflect traditional attitudes
towards community nurses such as District Nurses due to the nature
of the care that they perform. Community nurses have traditionally had
to be creative in the way in which they practice and deliver care in
the home setting. They are renowned for being able to ‘think on their
,‘This perception that GPNs were unlikely to require further post
registration training or education generally persisted to the 1980s.’
feet’: to adapt to situations and be resourceful in Definition of a General Practice Nurse
unpredictable surrounding and situations QNI (2008). General Practice Nurses work as part of a Multi-
Similarly GPNs have responded to a rapid expansion Disciplinary Team (MDT) within GP surgeries and
in their role by developing skills, gaining knowledge assess, screen and treat patients of all ages. In addition
and maintaining informal networks to disseminate to providing traditional aspects of nursing care such
good practice. The Royal College of Nursing as wound care, immunisations and administration
(RCN) practice nurse forum lobbied for specialist of medicines, they run clinics for patients with Long
practitioner recognition from the United Kingdom Term Conditions such as asthma, heart disease and
Central Council (UKCC) and this was achieved in diabetes. They also offer health promotion advice in
1994 (UKCC 1994); however this did not result in a areas such as contraception, weight loss, smoking
recognised qualification. cessation and travel immunisations.
In addition to their role in the management of Role of general practice nurse
LTCs and in the treatment room, nurses in general
practice have developed skills in the management of
patients with undifferentiated diagnoses and those PATIENT FOCUS
requiring unscheduled or urgent care. This has led to • Therapeutic relationships
• Patient advocate
the development of Advanced Practice Nurses and • Carers support
Advanced Nurse Practitioners reflecting the diversity MANAGEMENT • Self-management COLLABORATIVE
• Evaluation and review • Inter-professional working
of opportunities available. The DH Advanced Practice • Organisational skills • Complex care co-ordinator
• Caseload
Position Statement (2010) outlines the key element • Care management
•
•
Referral
Written and verbal skills
of Advanced Practice which include prescribing and •
•
Emotional labour
Resources
• Technology
referral. • Business acumen
General SKILLS
www.gov.uk/government/uploads/system/uploads/ EDUCATION & KNOWLEDGE Practice • Holistic assessment
attachment_data/file/215935/dh_121738.pdf • Graduate/Masters level Nurse • Clinical decision making
workforce • Clinical skills
• National and local policy • Communication
The introduction of Health Care Assistants (HCA) • Needs assessment • Curative
• Maintenance
to the Multidisciplinary Team (MDT) within general • Strategy
• Palliative
• Evidence-based practice
practice has contributed to this diversification. The role • LTCs
LEADERSHIP
• Role identity
of the HCA in General Practice tends to involve tasks • Health promotion/
improvement • Team Leader/Staff Manage-
such as simple dressings and the administration of ment
• Mentor
injections under Patient Group Directives, but is still • Visionary
relatively new and varies from practice to practice. • Autonomy
Figure 1. Created by Sharon Aldridge-
Bent (2012)
The Shape of Caring review (2015) chaired by Lord
Willis outlines its intention to improve the capabilities
of Health and Social Care Assistants and for Health The Future
Education England (HEE) to promote structured The Health and Social Care Act (2012) primary care
career development for these increasingly important saw the introduction of Clinical Commissioning
members of the workforce. The introduction of Groups led by GPs responsible for the commissioning
the Care Certificate to be completed by all new and delivery of health care. As a result many GP
HCAs during their induction is the first step. The practices are working closely together to redesign
Care Certificate is a first level introduction to the primary care services and consider how the MDT
fundamentals of care and consists of 15 standards might work in different ways.
that are assessed ‘in house’ during the first 12 weeks
of employment. ‘The Five Year Forward View’ (2014) stresses the
need to change the way in which health care is
Below are links to the Shape of Caring Review and to delivered and suggests ways in which health and
further information on the Care Certificate. social care organisations might change. As a result
it is predicted that General Practice Nurses’ and
• http://hee.nhs.uk/wp-content/blogs.dir/321/ community nurses’ roles will continue to change in
files/2015/03/2348-Shape-of-caring-review- response to the demands and challenges presented
FINAL.pdf by an ageing population with complex physical and
mental health needs.
• www.skillsforcare.org .uk/St andards/Care-
Certificate/Care-Certificate.aspx ‘Transition to General Practice Nursing’ - Chapter 1 - p2
, It is likely however that nursing in general practice will continue to offer
a diverse range of career options.
Different roles in the community
General Practice Nurses work with a wide range of health and social
care professionals. Trying to identify and establish all the different roles
will seem quite daunting to begin with. Here is a brief overview of the
roles to get you started:
The multi-disciplinary team
Community
Staff Nurse District
Community
Mental Health Nurse
Nurse
Health
SaLT Visitor
School
Physio- General Nurse
therapists
Practice
Nurse
Occupa-
tional Community
Therapists Matron
GPs Nurse
Community Specialist
Learning
Children’s Disability
Nurses
General Practitioners (GPs) - provide a complete spectrum of
care within the local community: dealing with problems that often
combine physical, psychological and social components. Most GPs are
independent contractors to the NHS. This independence means that in
most cases, they are responsible for providing adequate premises from
which to practice and for employing their own staff.
District Nurses - are qualified and registered nurses who undertake
further training and education to become specialist community
practitioners. They visit people in their own homes or in residential care
homes, providing care for patients and supporting family members. As
well providing direct patient care, district nurses also have a teaching
role, working with patients to enable them to care for themselves or
with family members, teaching them how to give care to their relatives.
Health Visitors- also known as a Specialist Community Public Health
Nurse (SCPHN) - Health Visitors work with families with children under
the age of 5 years. They support families and children in issues such as
growth and development, post natal depression, breast feeding and
weaning, domestic violence and bereavement. They also play a role in
safeguarding and protecting children from harm.
School Nurses - also known as a Specialist Community Public Health
Nurse - (SCPHN). School nurses work primarily with children in the
