POLICYPRACTICE STAFFING


Liz Price looks at changes taking place in practice staffing roles in Scotland – with lessons for across the UK


TRANSFORMING G


IVEN the continuing growth in chronic disease in the community – driven mainly by an ageing


population – the Scottish Government has been busy looking at ways to refocus nursing roles within primary care. A paper published in 2018 featured a new framework* introducing the role of non-clinical healthcare support workers (HCSW) to allow nurses in future to focus less on monitoring of care and more on prevention and management, including self- management and anticipatory care. These changes sit within a wider agenda designed to support a move in care from hospital to community and primary care settings, with the aims of improving population health, access to services and best value from health and social care services. This is also driven by a refocused Scottish GP contract which looks to support practices to better understand and meet the differential needs of local patient populations. A total of £3 million has been committed over three years to fund training provision to support changing roles.


MDDUS has been involved in a series of


workshops led by Greater Glasgow and Clyde health board, who are working with the West of Scotland Advanced Practice Academy to


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support practices through this transition. Our role was to highlight the medicolegal issues and regulatory responsibilities in relation to the changes for GPs, PMs and practice nurses, as nursing and HCSW roles in future will require to be more closely aligned with the national framework.


Whilst this is a change particular to Scottish


general practice, many of the points below will be of interest to practice managers across the UK in relation to service development.


OBLIGATIONS UNDER THE FRAMEWORK


Practice managers will now have a duty, along with the partners, to ensure that they have a clear understanding of the types of services their patient population will require and how this can be supported by practice nurses and HCSW roles. It may be that roles, along with job


descriptions, will require adjustment to reflect local priorities and necessary core competencies, and PMs should be making themselves aware of what options are available to their teams. From this position, PMs should be planning


how the practice can support competency development to close any performance gaps,


and this may mean allowing time for training which can be challenging, particularly in small practices. There will also be a need to risk manage the process by ensuring that supervision and support mechanisms are in place. Partners within practices have an obligation


to “ensure anyone you are delegating to has the qualifications, skills and experience to provide safe care” and to “ensure that all staff you manage have appropriate supervision” (GMC – Good Medical Practice). In future, all advanced nurse practitioners (ANPs) in Scotland will need to hold a master’s level qualification in advanced practice and meet all the required competencies for the primary care role. Existing ANPs will need to evidence that they meet the requirements before they can be recorded as an ANP on a list held by their Board, giving them additional authority. It is likely that GPs will be required to undertake workplace, clinical sign-off on these competencies, and should bear in mind their regulatory responsibility in relation to honesty and objectivity when appraising or assessing the performance of colleagues. If a nurse currently working as an ANP does


not meet the requirements within the new framework, it is perhaps worth knowing that


SPRING 2019  ISSUE 20


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