Manager Practice


NURSING ROLES


both the NMC and the RCN oppose the use of the ANP title without recognised training or competence. Set against the new framework, this could pose a problem if only until gaps are plugged. If the practice is looking to recruit an


ANP from outside primary care, they will be required to assess any gaps in that individual’s knowledge and competencies relevant to the primary care role and plan to plug these. Also, if an ANP is recruited from an out-of-hours setting, their competencies are more likely to be closely aligned to primary care than if they trained as an ANP in oncology, for example.


ESTABLISHING COMPETENCIES Once future service needs have been established, the nurse should work with the PM and partners to consider where training and development is required. Any gaps in competencies in relation to


the new framework or defined requirements (for example the nurse may fulfil all the competencies required to be classed as a senior practice nurse (Band 6) but may not be a non- medical prescriber) should be addressed with appropriate support and access to training. It is very important that the nurse, or a HCSW, is not expected to work outside the


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scope of their current competencies and, indeed, nurses have a regulatory duty to raise concerns with their employer and to ensure they ask for help. The nurse’s aspirations should be


considered alongside the requirements, and (for example) if an ANP role is to be introduced, it could be that the practice can plan the change over a period of time in order to support the current practice nurse to progress their career to meet this need. Practice nurses are most likely going to have


the lead role in developing HCSWs to learn new skills within the framework – and nurses have similar regulatory duties to doctors in relation to delegation and supervision. By supporting the development of other non-clinical staff in expanded HCSW roles, it is likely that practice nurse time can be released for other activities that require clinical expertise. It is equally important that both nurses


and HCSWs expanding their skills are supported to ask for help at the interface of care or boundary of competence between themselves and other team members. For example, the nurse should feel confident to ask a GP to review a patient for them, and the HCSW should feel they can stop and ask a nurse for advice or support.


TAKE A CONSIDERED APPROACH Although there are no set timescales for the framework changes to be implemented, there is now a clear direction of travel for GP practice development of nursing and HCSW roles. I would urge practice managers to take


a slow and steady approach to managing the required changes. Ensure you access employment law advice as and when appropriate to risk manage changing roles as, in my experience, some HCSWs and practice nurses will be worried about what the changes mean for them and what the practice will expect. They will also perhaps be nervous about new roles or undertaking training, and will need support through the process. Our experience is that team members are much more likely to embrace the challenges – and opportunities – ahead if a collaborative approach is taken to understand patient population needs and to identify how service development will best meet these needs and benefit patients.


Liz Price is senior risk adviser at MDDUS


* Developing the general practice nursing role in integrated community nursing teams. Scottish Government, December 2018


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