Framework for Nursing in General Practice
Guidance and support materials fro general practices on the employment and development of nurses
Framework for Nursing in General Practice
Why produce a framework for nursing in general practice?
Practice nursing is a rapidly developing field of nursing practice, with numbers in Scotland doubling over the last 10 years (ISD Scotland 2004). Practice nurses are expanding their scope of practice to accommodate the new demands of patients and the public for modern primary care services. Nurses are often attracted to practice nursing because of the potential to expand their clinical practice and the ability to work within a small organisation.
However, it has not always been easy for practices to make the most effective use of skills of the nurse members of their teams. Practices, as very small organisations, have little access to Human Resources expertise or professional nursing leadership to support the development of their nursing staff. Yet there is an increasing expectation on behalf of practice nurses that they will have equal standing and terms and conditions with their NHS staff. The implementation of Agenda for Change will undoubtedly increase the expectations of practice nurses seeking parity with their NHS colleagues.
The new General Medical Services (GMS) contract, one of a number of strands of pay modernisation that run across the whole NHS family, creates many new opportunities for practices and for practice nurses, who it has been argued will play a critical role in helping practices achieve quality targets. The practice based nature of new GMS creates opportunities for practices to meet the needs of their populations in different ways, changing skill mix, developing new roles and even exploring nurse partnerships. The particular emphasis on Chronic Disease Management will create new opportunities for practice nurses to build upon existing expertise in this area. At the same time, the Agenda for Change strand of pay modernisation provides a new set of proposed terms, conditions and pay scales for the bulk of NHS staff including nurses. Practice nurses are keen to benefit from these new terms and conditions, and NHS Boards will need to provide support and HR expertise to those practices wishing to implement Agenda for Change for their staff.
This framework sets out a series of standards and supporting good practice guidance for practices to equip them to effectively and safely develop and support their nursing staff in the challenging environment of modern primary care.
How was it developed?
Development of the framework consisted of two main strands.
1. Practice nurses from across Scotland were involved in local workshop discussions about their roles, identifying strengths and areas they felt needed to be developed in order to be more effective. This culminated in a consensus workshop attended by over 200 people, including practice nurses, GPs, practice managers and NHS Board managers and nurse leaders. This process identified a number of common issues which nurses and other key stakeholders agreed needed to be addressed. These included:
Access to learning and development opportunities.
Leadership and professional support.
Profile and perceptions of practice nursing among peers.
Networking and peer support.
Autonomy and accountability
These topics are summarised in Annex A.
2. A set of standards for the employment and deployment of practice nurses was developed. The standards were drawn together from a number of sources. The majority were drawn from the new GMS contract, which sets out a number of standards around practice nursing, and the NHS Scotland Staff Governance Standards. In addition, standards were mapped against Practice Accreditation and Quality Practice Award standards.
The standards were then used as the basis for the framework, with the chapters of support materials developed to cover the main points in the standards.
The development of the framework was overseen by a multi-disciplinary steering group, who met at key points during development of the framework and contributed to the development of the detailed chapters.
NHS Scotland Staff Governance Standards
The NHS Staff Governance Standards have been developed by the Scottish Partnership Forum and the Human Resources Forum. They represent a statement of good employment practice, based on current employment law. For NHS Scotland employers, there is now a statutory requirement under the NHS Reform (Scotland) 2004 Act to commit to achieving them. The standards are aspirational and it is recognised that they cannot be achieved overnight. General Practices, as independent contractors, are not legally required to meet those standards. However, there is an expectation that Community Health Partnerships should seeek to commend best practice to all employers within the CHP, for the benefit of all employees and in turn for the benefit of patients and carers.
The standards have provided a useful foundation for this framework, where they have been interpreted into a context that will be relevant to practices and will help them achieve standards set out in the GMS contract.
The NHS Scotland Staff Governance Standards state that staff are entitled to be:
Involved in decisions which affect them.
Treated fairly and consistently.
Provided with an improved and safe working environment.
What is the framework and who is it for?
Practices in Scotland vary considerably in size and there can be no one right model for all. Some may have large and varied clinical teams, others may have only a single GP and a part time nurse. The standards have been written to be relevant and applicable to all settings, although clearly some will be more relevant to each practice than others. All of the standards will need to be interpreted and applied by individual practices within their own context of geography, patient need and staffing resources. They are intended to be developmental and aspirational rather than an absolute minimum, although there are clearly some areas where legislation establishes a minimum standard that must be met by all employers.
The framework has been written to be a helpful resource for practices and practice nurses. It summarises and interprets a wide range of current legislation and policy in relation to the employment and development of practice nurses. It is not intended to be a definitive statement of any of the current legislation and policy, but makes numerous links to authoritative guidance, which should be of help to practices in developing their practice nursing service.
There are 11 standards in total covering the following six areas which form the structure of the main chapters of the framework:
Fair and consistent treatment.
Induction and initial preparation for role.
Developing the nursing team.
Learning and development.
Communication and teamwork.
Accountability for professional practice.
Each is set out in the form of a standard statement and a number of criteria which break the standards down into more detail.
Using the Framework
The framework is intended to be a resource for practices. Whilst the standards represent a coherent whole, each of the chapters can be read on its own and the resources on the CD ROM can be used independently or collectively, adapted to meet the specific needs of the practice. The framework is fully indexed to support this.
Practices could use the framework to help demonstrate achievement of a number of organisational standards within the Quality and Outcomes Framework and could also demonstrate achievement of a range of standards within the RCGP's Practice Accreditation and Quality Practice Awards and Fellowship by Assessment for Nurses, developed by Queens Nursing Institute (Scotland).
Practices will not be assessed against the standards in any formal way, although it is recognised that individual practices may find it helpful to self assess against the standards as part of their own development plans.
Whilst the framework will be a useful resource to practices as it stands, additional support will be needed to help those practices who choose to use it as a developmental tool. CHPs will have a critical role in providing local leadership and support and in promoting good practice across the CHP. Similarly NHS Boards will have a contribution, particularly in providing support to practices wishing to implement Agenda for Change. At a national level work is underway to develop a support network which will promote good practice and encourage practice nursing development.
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