GP mythbuster 26: General practice nurses

Page last updated: 5 July 2022
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On inspections we consider whether staff, have the skills, knowledge and experience to deliver effective care and treatment. This includes general practice nurses (GPNs). GPNs are sometimes referred to as practice nurses.

Training

For nurses who wish to work in primary care, there is no standard, mandatory entry level training. Their specific training needs depend on the role they are being employed to do. This varies between and within practices. An effective induction process should identify specific training needs.

Depending on their professional background and experience, a new general practice nurse may already be competent in some aspects of the role. For example, wound care and venepuncture. They will need to gain other skills once they are in post, for example immunisation, management of long-term conditions and taking samples for cervical screening.

A foundation course in practice nursing will provide the required theoretical knowledge. This knowledge must be supported with supervised practice in the practical setting.

In 2018, Public Health England (now UK Health Security Agency) published:

Read further information in GP Mythbuster 104 Cervical screening.

Registered providers have a duty to ensure staff are competent to undertake all aspects of their role. Staff who are learning new skills, but are not yet competent, should be appropriately supervised.

There should be a system of governance in place. This enables the provider to show how they have assured themselves of the competence of their team of general practice nurses. team.

Existing practice nurses may develop their academic knowledge and capabilities to work as advanced practitioners. Read GP mythbuster 66: Advanced Nurse Practitioners (ANPs) in primary care for more information.

Supervision

Clinical supervision is effective in making sure a nurse remains clinically competent and that they are learning to improve their skills. Clinical supervision can be part of the process to help nurses to revalidate. It should:

  • be undertaken with a suitably-trained peer
  • follow a framework
  • be documented.

Appraisals

GP practices are responsible for supporting staff to deliver effective care and treatment – this support includes effective appraisal. Staff should have had an appraisal in the last 12-month period. They should be able to describe the impact of this on their practice.

The role of the appraiser will vary depending on the size and people in the individual practice. In a larger nursing team, this is likely to be a lead nurse or nurse manager. In many GP practices this will not be possible, so a GP, a practice manager or both may carry out appraisals of nurses.

Continuing professional development (CPD)

Nurses must have undertaken CPD to enable them to revalidate with the Nursing and Midwifery Council (NMC) every three years. This must be at least 35 hours of learning activity relevant to the nurse’s practise. Nurses need to show how the learning activity has informed and influenced practice.

All areas of professional practice require regular updating.  This includes but is not limited to, updating of immunisation knowledge which should take place at least annually and when there are changes to the vaccination programme.  The subjects that should be included in updates are specified in the minimum standards and core curriculum for immunisation training document.  Sample-takers for the cervical screening programme should attend three yearly updating.

Registered providers have an obligation under the Regulations to ensure staff, including GPNs, are able to meet the requirements of professional regulation as set out by their regulator.

Employing GP practices should:

  • make sure staff, including practice nurses, have the right skills, knowledge and experience for their job
  • identify their learning needs so they receive appropriate training for each part of their role
  • encourage general practice nurses to develop and provide opportunities to do this.

NMC registration and revalidation

Nurses cannot legally practise in the UK unless they are registered with the NMC. A GP practice that employs nurses must make sure they are registered before they begin work. Practices need to check their registration regularly throughout their employment, including locums and temporary staff.

If a nurse is an independent prescriber, this qualification should be on the NMC register. The employing practice should use the up to date NMC registration confirmation service, as any paperwork the nurse provides is only valid on the day it was issued.

Nurses are required to revalidate with the NMC every three years. Revalidation:

  • demonstrates a continued ability to practice safely and effectively
  • raises awareness of the Code and professional standards
  • encourages nurses to stay up to date in professional practice
  • strengthens public confidence in the nursing and midwifery professions.

Practice nurses need a line manager to act as ‘an appropriate confirmer’. This does not have to be an NMC-registered nurse, midwife or nursing associate. For example, it could be a GP or practice manager

Although revalidation is a nurse’s responsibility, the employer should have systems to make sure nurses have completed their revalidation.

Indemnity insurance

The Clinical Negligence Scheme for General Practice (CNSGP) provides insurance cover to all staff delivering NHS-funded care in NHS general practice in England. This includes GPNs locums, self-employed workers and trainees. NHS Resolution operates the scheme.

There are limitations to the indemnity scheme. For example, it does not cover work outside of NHS contracts including:

  • giving vaccines that are not available on the NHS
  • acts of kindness or ‘good Samaritan’ acts
  • occupational health tests and injections
  • professional regulatory matters.

The Royal College of Nursing provides guidance on the RCN indemnity scheme and changes to the scheme.

When we inspect

To meet Regulation 19 (Fit and proper persons employed) employers must have robust recruitment procedures, including any relevant checks, to assure themselves about workers they employ to carry out regulated activities, including locums.

When we inspect, we consider the competency and development of all staff, including general practice nurses, by asking the following questions:

  • Are people’s needs assessed, preferences and choices met by staff with the right skills and knowledge?
  • How are the learning needs of all staff identified? Do staff have appropriate training to meet their learning needs to cover the scope of their work. Is there protected time for this training?
  • Are staff encouraged and given opportunities to develop?
  • What are the arrangements for supporting and managing staff to deliver effective care and treatment? (This includes one-to-one meetings, appraisals, coaching and mentoring, clinical supervision and revalidation.)

GP providers must be able to show how they:

  • make sure general practice nurses are, and continue to be, competent
  • have systems in place to support clinical supervision
  • support them to fulfil their NMC revalidation process to be assured of their ongoing fitness to practise.

 

GP mythbusters:

Clearing up some common myths about our inspections of GP and out-of-hours services and sharing agreed guidance to best practice.

See all issues:


We review our mythbusters regularly. Contact us with your comments and suggestions.