RCN Practice Nurse Association UK conference

1. RCN Practice Nurse Association UK conference Celebrating 25 years: now going for gold

2. “GP Super clinic” ……. out of Coronation Street Oak Park Primary Care Centre - Ashville Medical Clinic • Centre was purpose built (2 years old). • Low socio-economic area, a mining community with an aging population & old health facilities. • Super clinic based on Cuban model of health care Barnsley, Yorkshire

3. The Practice Nurse’s Workplace. • Each practice nurse has her own room & computer equipment • There is a large treatment room & mini theatre with all the latest equipment • The practice nurses are able to prescribe drugs a (6 month training program is required to become a nurse prescriber) • Nurses have all their clinical protocols on line. • The practice nurses work mainly on CDM – wound management is usually referred on to district nurses • They run patient education courses – expert patient courses – self management & diabetes education courses The centre has a range of staff running the practice side of the PCC: • Health assistants • 6 GP’s • RN’s • Nurse practitioners • Clinical nurse consultants • Child health nurse • Medical receptionist • Practice Manager

4. Nurse Partner - Wigan • Wendy is a nurse practioner & had worked in the practice for a few years • The practice had trouble finding suitable GP partner’s • Offered Wendy a partnership (£6,000 or $13,000 Aus). • The GP clinic was a rented the building – the old premises had no space • 2-3 years ago they moved the surgery into LIFT building (Local Improvement Finance Trust) Wigan’s LIFT Company, Foundation for Life (FfL). • http://www.dh.gov.uk/en/Procurementandproposals/Publicprivatepartnership/NHSLIFT/index.htm Wigan is a large town in Greater Manchester, England. It stands on the River Douglas, 15 miles (24.1 km) south of Preston, 16.5 miles (26.6 km) west-northwest of Manchester, and 17.4 miles (28.0 km) east-northeast of Liverpool. Wigan had a total population of 81,203 in 2001.

5. The Nurse Partner’s Role • Involved in the business and day to day management of the practice, provides on call service & student supervision • She runs her own clinics • She refers – directly to hospital /specialist not through GP’s • The practice runs a triage service – morning clinic –jointly shared • Gets paid as much as a GP !! • Email wendy.fairhurst@gp-p92642.nhs.uk

6. CELEBRATING 25 YEARS OF PRACTICE NURSING City Hall Cardiff July 2008

7. The Development of the Practice Nurse Role Key Note Speaker: June Smail OBE – Non executive director Velindre NHS Trust, Wales • The first practice nurse conference was held in 1984. • In the UK the Practice Nurse Association is part of the Royal College on Nursing • Practice nursing in the UK has changed from the late 60’s to early 70’s from a nurse receptionist role & treatment room work • Practice nursing numbers • 1977 – 1,500 • 1990 – 13,280 • 2005 – 22,904 (and still increasing)

8. Early 1980’s practice nurse interest groups were set up, short courses were offered to nurses • 1984 the first conference, need for a educational pathway & RCN standards of care • 1990 Numerous Diploma courses (Diabetes, Asthma, Women’s health Pap Smears) & Damant Report “Practice Nursing: Stability and Change: Margaret Damant, C. Martin, S.” “The debate about the role of the practice nurse is not only about practice nursing per se, but raises broader issues about the organization of primary health care. Two related issues emerge as significant the role of the practice nurse in providing primary health care, and the effective use of the practice nurse resource in the 'new' National Health Service” • 1994 a degree course for practice nursing was developed & common foundation programs were set up

9. Practice Nursing Now 25 Years Later • Nurse practitioners in general practice (Masters level - extra 2 years post grad) - lot more professional respect • Nurse led clinics • Nurse partners in practice • Nurse led general practices (they employ the GP) • Walk in clinic (new) (clinics set up in local shopping areas - anyone can be seen by nurse / GP (not regular GP) • UK career framework & general practice nurse (GPN) tool kit www.rcn.org.uk/gpntoolkit • Nurse Prescribers * • Now champion PN’s are involved in education and teaching -There was a need for CPD – that was relevant, interesting and challenging.

10. Nurse Prescribers • There are almost 398,000 nurses in the NHS making them the biggest single staff group in the NHS. • Since May 2005 nurses who are trained to prescribe independently from the Extended Formulary may prescribe from a list of around 240 Prescription Only Medicines (POMs) to treat 110 medical conditions. • Over 4,600 nurses are qualified and registered with the Nursing and Midwifery Council to prescribe from the Nurse Prescribers' Extended Formulary. Many more nurses are currently in training and around 175 more nurses a month are qualifying to prescribe. • Over 28,000 district nurses and health visitors are also now trained to prescribe from a limited formulary of products for patients in community nursing. • They wanted 5,000 PN’s to be trained up but they have only managed to train 3,000 so far • 6 month training course

11. The GMS Contract: What impact has it had ? • In 1990 a new GMS contract was developed (focus on health promotion and CDM) 1/3 practice income comes from meeting the QOF targets • 146 evidence based indicators,76 in 10 clinical areas GMS contract has enabled nurses: • To be more involved with practice decisions • Have a extended role • Nurse partnership • Business aspects – buying into practices

12. 2005 practice nursing grew from 13,800 – 23,000 41% growth of PN’s in 10 years • 46% of practice nurses are over 45 years • 85% work part time • In 2004/5 – 91.3 % reached the target indicators (QOF) • 2006/07 – 95.5 % GP’s reached targets 1000 points. • Early data suggests some moderate improvements in some LTC Diabetes. • In 2006 the QOF was modified to 135 indicators. • 15 indicator in 7 clinical areas (added palliative care, learning disabilities and depression) • Move to patient centre care • More than ½ QOF can be lead by the PN which 50% total quality points

13. Limitation of the QOF • NICE recommendations are evidence based QOF indicators do not match (National Institute for Health and Clinical Excellence) NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health http://www.nice.org.uk/ • Training for practice nurses has decreased, the Trusts do not get the funding for education any more it goes directly to the practices. • GP wages have increased by 58% from £72,000 to £130,000 • But not for the PN’s. Low morale, increase in workloads, less training and no financial incentives. • GP’s have retained the gate keeper role and have pushed the QOF onto the PN’s NHS white paper 2006 • http://www.archive.official-documents.co.uk/document/doh/newnhs/contents.htm

14. THE RCN PRACTICE NURSE ASSOCIATION Kate Howie – Chair RCN – PN Association What the PN organisation has been doing in the last 12 months: • The Practice Nursing Association is part of the RCN in the UK • National patient safety – strategy (Immunisation) • Developed standard for minor surgery in Primary Care • HPV Vaccine – produced information for PN’s • Work with the Working in Partnership Program – Tool Kit • Expert patient program • Developing standards etc for nursing assistants role • Run nursing education forums • Member – editorial community (two PN nurse journals) • Write a monthly newsletter • Work together with RCN – Sexual Health in Practice web education / training resource www.in-practice.org. Has a good section on taking a sexual health history

15. CONFERENCE TOPICS The Contribution of Practice Nurses to Community Health Dr Marion Lyons - Lead consultant in Communicable Disease Control, Director of Sexual Health Services (WAG). National Public Health Service Wales Practice Nurse Role in Public Health • Screening • Nutrition and Healthy Lifestyle • Smoking • Breast feeding • Immunisation • Pregnancy – Next step is to have more involvement in the community

16. Move to Practice / community approach • Practice population • Target needs • Target services – vulnerable people • Local needs assessment • Develop community strategies – promote health communities • Develop family centred care • Life long learning – local health alliance (partnership) with education others. Need to develop a practice nurse public health network • That is multi disciplinary • Evidence based data base (what works and what doesn’t) • Developing communities to change – opportunity valued rather than just focusing on individuals Reference: RCN Nurses as partners in delivery public health 2007 http://www.rcn.org.uk/__data/assets/pdf_file/0011/78734/003114.pdf

17. COMMON CHILDHOOD ILLNESS Phil Hammond qualified as a doctor in 1987, became a GP in 1991 and has also worked in sexual health. • Hammond co-authored Trust Me I'm a Doctor (Metro books) with Michael Mosley, the executive producer of the BBC2 series of the same name • Comedy – the last of the single hander’s (GP’s) • He wrote with a strong pro-patient-rights line. He has since starred in his own show 59 Minutes to save the NHS at the Edinburgh Fringe • Ran quiz – why do children die • Key messages • We need have a Chronic Disease Management register for at risk children

18. IDENTIFICATION OF SEXUALITY David T Evans RN BA (Educational consultant in sexual health University of Greenwich) “But how can “I” have a sexual infection - I don’t have sex: I am the only gay in the village’” • Spoke on gay and lesbian health. • Appreciated the need for challenging and overcoming all forms of sexuality related stigma and discrimination in general practice • Identify sexuality related health care issues for lesbian and gay patients, especially those which need to be (proactively) addressed for the improvement of health and well-being • Clarify the benefits of health of an inclusive, non-discriminatory service

19. DR, AM I A VIRGIN AGAIN? TEENAGE SEX ISSUES Professor John Guillabaud GP Professor of Family Planning and Reproductive Health, University College London • UK has the highest teenage birth rates in Western Europe - twice as high as in Germany, three times as high as in France and six times as high as in the Netherlands. • Why are the figures on the increase? • One thing that is lacking in the UK is a consensus on how to deal with the problem of pregnancy and sexually transmitted infections (STIs) among teenagers.

20. BEING A MAN IS A RISKY BUSINESS Jane DeVille –Almond Independent Nurse Consultant, Both Vice president and chair of both the Men’s Health & National Obesity Forum. • Men accessing health services – why they don’t come to GP clinic • What do men like – sex, food, booze, risk behaviour (fast cars etc) sport (survey) • A man is only half as likely as a woman to visit the doctor, especially to discuss male-specific illnesses. • However, a new method of taking clinics to men – in pubs, barber shops and motorcycle meetings – has been a huge success • http://www.menshealthforum.org.uk/userpage1.cfm?item_id=276 • Her approach gets results. Health screening men in pubs yielded a 70 per cent identification rate of men with long-term health problems. The same exercise in a GP practice for one year, threw up just 4 per cent. Jane now hopes to take her clinics onto commuter trains - 'It's about having imagination,' she says

21. LONG TERM CONDITIONS – A Major Issue for HealthcareSue Thomas – RCN London • LTC (long term condition or CDM) has moved up the political agenda • 15.4 million people UK have a long term condition • LTC will rise 23% over the next 25 years • LTC – take 69% primary and acute budget

22. Some Other Topics • NEW ZEALAND Mark Jones– Chief Nurse , Ministry of Health New Zealand. •  NZ they have 1/10th number of nurses as UK Challenges in NZ, access to education (appropriate), Pay & conditions, Professional development • THE TELECARE PROJECT. Communicates to patient – send them weather conditions to tell them not to go out etc (In the UK TV is a big part of aged entertainment)  7,000 people connected to telehealth and telecare in their homes • IMPACT OF AGING SEX AND MENOPAUSE. Keeping sex alive in the later years - Dr Annie Evans

23. YOUNG PEOPLE AND SUBSTANCE MISUSE Trudi Peterson RMN  Recognises the potential of the practice nurse in identifying substance use and misuse issues among young people. • DOMESTIC VIOLENCE AND THE ROLE OF THE HEALTH PROFESSIONALLynn Lynch MBE. On average people are abused 35 times before they report it. 20-30% of all assaults in emergency are from DV • EXCITING TIMES AHEAD – a progress report of the Australian experience - Anne Matyear- APNA • WIPP NATIONAL LEAD PROJECT – Sue Cross, practice nurse career structure

24. Lesley’s Key LearningsTo be developed further in consultation • Australia is not that far behind the UK in practice nursing • We need a government policy change – to increase nurses role • Need a national career path for practice nurses (orientation program, grad cert - need to develop a master level (nurse practitioner) program • It is very important that practice nurse education/professional development runs through divisions • Need to keep division program officers involved in nurse training • Need to develop more practice nurse specific education – (short courses) on a variety of topics: Child health, Men’s health, Travel health, Sexual health, Child protection etc • APNA (out on its own) In the UK PNA is part of RCN. Clarify the division's role & APNA . Division support nurses in the work place (practices) APNA – supports the practice nurse profession

25. Thank you GPV for giving me the opportunity to go to the UK as this has given me the ability to see where practice nursing need to go in the future !