Nursing in Primary Care

Great work is being done up and down the country by general practice nurses and other members of the profession based in primary care settings, often under formidable pressure due to demand on their services. Launched in 2023 and returning this year is our award specifically for primary care nursing. Primary care services are the ‘gatekeepers’ of healthcare provision, meaning nurses working in such settings play a vital and varied role for their patient population, often being the most regular and recognised contact for both younger and older patients. Among many other things, they will assess, screen, treat and educate patients, as well as supporting other members of the primary care team. In particular, they will take a leading role in helping patients to manage long-term conditions and minimise its effect on their life. This award category sets out to celebrate either an individual nurse or nursing team that has made a real difference to the provision of care in their practice. It is open to those working in the NHS or independent sector and from any primary care setting. Entrants must be able to demonstrate their work has improved patient care or the effectiveness of their service and has outcomes to demonstrate this.

BrisDoc Healthcare Services
Homelessness cervical cytology

Homeless women often experience severe and multiple disadvantages, this severely impacts on their ability to access timely and appropriate health care and as a result of this are at increased risk or mortality and morbidity. Homeless women have the average life expectancy of 43 with almost a 3rd dying of preventable illnesses including cervical cancer. Homeless women face multiple barriers to accessing cervical cytology including not receiving or reading their invitation letters or follow up letters, high prevalence of sexual trauma, lack of washing facilities and complex intersecting substance misuse and mental health problems. With the Support of a volunteer GP the HHS nursing team were able to identify over .157 women who were either overdue a smear test or lost to follow up for existing smear tests, SWAG funding was procured and the HHS team hosted a treating event on trauma informed care for homeless women and the importance of cancer screening for homeless women. This training event was aimed at support workers working across housing and homelessness sector who would be supporting women to attend healthcare appointments. Availability of smear testing was widely publicised and an outreach clinic at a homelessness women's shelter has been set up with plans to attend women's hostels across the city. One of the biggest challenges was accessing up to date records for our patients, many patients at HHS only hold a temporary registration although they may access all their healthcare from us and so each record had to be individually looked up, cross checked and have alerts added to our notes. This was incredibly time consuming and could not have been achieved without a significant time investment from the volunteer GP. There were also concerns about opportunistic screenings being rejected by the laboratory as they were not 'due'. 

Connect Prescription Management Service
Connect prescription management service

The cost of stoma-based prescriptions is increasing year on year. This growth has accelerated faster than the growth in patients. Most patients experience problems with their stoma at some point; skin irritation, blockage, leakage, difficulty with stoma pouch etc. Issues and complications can arise at any point in a patient’s journey and can be swiftly resolved when prompt advice is sought from a trained specialist stoma care professional. The Association of Stoma Care Nurses (ASCN) UK recommends ongoing access to a Stoma Care Nurse (SCN) for all people living with a stoma, providing crucial support and advice to help inform product selection, improve patients’ quality of life (QoL) and treat arising problems promptly, thus avoiding hospital admissions and appointments with GPs. However, in many regions, the availability of long-term care and access to specialist advice for stoma patients is inconsistent, and many patients struggle alone. Connect Prescription Management Service was developed by a Team of Specialist Nurses, backed by a private sector organisation and commissioned by Nottinghamshire NHS Acute and Community. Recognising the need for a more cost-effective way of managing prescriptions, controlling increases in spend, and improving the long-term clinical care for people living with a stoma. Connects mission is to connect patients to the right care, at the right time, support their individual needs, deliver the highest quality health, outcomes and improve their overall safety. Through a combination of knowledgeable patient coordinators and specialist nurses, Connect triage patients, prescribe instantly, and provide ongoing support with face-to-face and community nurse visits. They give patients individualised care exactly when they need it, while at the same time reducing product costs and wastage to the NHS. Connect is a specialist prescription management service that bridges the gap between acute and community care. Geographical expansion is the future, to serve more patients.

Hartlepool Health Primary Care Network
LOGIC – holistic proactive management in COPD

The practice involved has the third highest rate of COPD hospital admissions and the plan was to ultimately reduce winter pressures by increasing the provision of holistic, meaningful annual reviews that would in the short and long term result in:1. Reduced antibiotic and oral steroid requirements for COPD patients. 2. Improve quality of life of COPD patients measured by CAT scores.3. Improve the knowledge of staff managing COPD patients with mentorship4. Improve patient health literacy skills and COPD plan use5. Reduce the amount of open triple therapy where appropriate. Patients were risk stratified and those with high risk of exacerbation and high symptom load were invited for review first followed by those with a high exacerbation risk and then those with a high symptom load. 252 patients were reviewed in total. Staff with an interest in respiratory disease were asked to volunteer for mentorship. It was made clear we would like to start with staff with a keen interest in learning more who could apply their knowledge on a daily basis. Staff were mentored in clinic with me with follow up support. Their decision making was discussed as well as any learning needs they identified. Patients were reviewed after a month and at three months. North East and North Cumbria Integrated Care Board have expressed an interest and are currently discussing how this could be rolled out across the region, potentially identifying respiratory champions who can work with practices throughout the area.

Lancashire and South Cumbria Primary Care Training Hub
Life journey pathway placement

The Life Journey Pathway project emerged to help resolve the following within Primary Care: Re-establish placement capacity in primary care placements  Create additional placement capacity in primary care settings across Lancashire and South Cumbria Training Hub  Improve communication and sharing of placement opportunities between primary care, trusts and wider community placement networks  Support clinical educators maintaining existing placement capacity and developing new placement opportunities  The project was developed in partnership with Lancashire and South Cumbria Primary Care Training Hub (LSC PCTH), Social Care, HCRG Care Group, Learner Quality Ambassadors, Service User Representatives, Edge Hill University, University of Central Lancashire, University of Bolton, and University of Cumbria. This pathway is a unique and innovative placement encompassing a 'Person’s Life Journey through Health and Social Care', underpinning the journey from birth to death. Learners experience includes allocated time within all 3 sectors. Allowing learners to gain a holistic overview of the person, the care they receive, and the services they access across their life journey. There have been many challenges throughout the pilot section of the project. Key challenges: Placement development within Primary and Social Care settings Allocation of learners from HEI’s Locality of learners to available placements Life Journey Blended Learning for Case Study Learner absences during pilots Practice Assessment Record and Evaluation (PARE) system not being able to accommodate a placement that incorporates different organisations within one placement Raising Concerns about infrastructure both at the organisational and Higher Education Institutes (HEIs) level The overall viewpoint on the Life Journey Pathway Placement from all stakeholders and learners who have accessed the pathway is that this is a worthwhile project with recognition of the lessons learned, incorporating the recommendations and addressing challenges, the initiative can be further refined and expanded to provide a transformative educational experience and shared with the wider System.

Lancashire and South Cumbria Training Hub
Interprofessional placement model

Issues:• Learners are classed as ‘supernumerary’ during placements, this can result in only observing and not participating in activity as much as they are able too. • Learners within Primary Care do not often get the opportunity to work alongside another learner from a different educational pathway.• There is no standardisation for placements across primary care, resulting in a variation of experiences with no consistency across the sector.• Learners are often not always provided with the opportunity to develop their leadership, team working, and decision-making skills during placement within Primary Care.• Learners often have little understanding about the different roles and responsibilities in primary care. How: We approached the local Universities for support around the different learner pathways and timetables. We looked at the expected outcomes of the learner’s curriculum to ensure the competencies were achievable during the project. We sought support from the stakeholders and Practices to ensure the project was a viable option. We met with the learners at the start of their placement, provided robust information about the project, including the aims and the structure. We facilitated learners on different educational pathways to work together and support each other to run a healthcare clinic within a Primary Care setting. Challenges: Contacting the “right people “at the “right time” – Universities and Stakeholders. Clinicians had initial reservations and a nervousness about a different way of supporting learners. Including learners on different educational pathways meant that their timetables did not match. Future Plans:• Replicate the model across the region initially, then look to the wider. • Paper in draft for publication. • Showcasing the project within individual healthcare professional, practice and PCN meetings / forums.• Working with training providers to promote Primary Care as a career option upon qualification.

Nottinghamshire Alliance Training Hub
General practice nurse mid-career fellowship

Issue: To support General Practice nurse retention. The aim of the pilot is to open up opportunities for professional development for those not wanting or currently considering the Advanced care practitioner pathway, but who are still wanting to professionally develop and enhance their skill set linked to their role as a practice nurse. I looked at opportunities available to GPs and the ARRS role colleagues and consider responses to a local GPN survey I had undertook in 2022, which lead me to create and develop this opportunity. Quality improvement work is important and vital to development and improvement of delivering primary care services, supporting staff well being and improving patient outcomes. As nurses develop within their careers they are sometimes put into roles, such as lead nurses and expected to undertake certain leadership duties, audits or QI work without the proper support and training. The Mid Career Fellowship offer is to support practice nurses have 4 hours of paid, protected time a week to undertake a quality Improvement projects linked to their workplace or to CN priorities. The fellowship offers training in effective communication, project management, quality Improvement techniques, research, writing for publication and poster presentations to help them evaluate and present the work they undertake. As part of the fellowship they are also supported to learn more about themselves and their strengths through the ENA and MAZI programme. They have access to ongoing mentoring via a facilitator and an end of programme celebration to showcase their learning and present their QI projects. The fellows are also supported to use their protected time to undertake training such as the QSIR practitioner course or Edward Jenner programme, to ensure they get the most out of the time on the fellowship programme.

Royal Wolverhampton NHS Trust
Supporting health inequalities in primary care

Within our Primary Care Network, we have a high number of asylum seeker patients who have registered with our practices. They are from various countries and use several different languages. Engagement with these patients alongside the language barriers has been difficult and specifically in relation to attending practices for cervical screening, vaccinations, and child immunisations. We obviously want to provide the best care for our patients as their health is of the utmost importance to us so trying to engage and promote these procedures is vital. A year ago we undertook a PCN Development Programme and focused on cervical screening based on the population at our one practice where the uptake was really poor (this practice is the main one that asylum seekers registered have registered with), however, we did include all patients and practices within this programme. We looked at the barriers and why patients were not attending, this information was taken from a survey that was sent to patients who were eligible for cervical screening. The results gave us some background and evidence to work through the barriers identified. We introduced extra clinics including weekends to support access for patients, sourced leaflets in various languages, used interpreters when required and added information and videos to our website. We also focused on increasing access for the homeless population within Wolverhampton and have worked closely with a local hostel to ensure people without a registered home address in Wolverhampton can still receive the care they need. Our nurses have attended a couple of Welcome to Wolverhampton events for the new asylum seeker population where they have been promoting vaccinations, child imms, cervical screening and advising patients of dates they will be holding clinics and booking patients in for appointments whilst at the event.

Serco Group, Mental Health Innovations UK and Unify Business Solutions
SHOUT for prisoners

The National Audit Office report on mental health (2017), calls for an urgent ‘step change’ in efforts and resources to support mental health in the community and in prison. In the community, patients are increasingly able to access family and other support in ways that are unavailable to prisoners, e.g. online applications. Now more than ever, being in prison has a major impact on prisoner wellbeing. It is therefore incumbent upon us to support the most vulnerable prisoners with innovative methods and tools. Historically, a text service to support mental health in prison has been impossible as phones/technology are not readily available or have limitations in a custodial environment. However, Serco, alongside Mental Health Innovations and Unify have collaborated to scope, build and develop a technology to enable such access to SHOUT.SHOUT is a confidential mental health text service that supports people in crisis with issues such as suicidal thoughts, abuse or assault, self-harm, bullying and/or relationship challenges. On reaching out to the service, individuals receive help to move from a moment of crisis or distress to a place of calm, and then further support to create a joint safety plan to mitigate future crises. Serco, MHI and Unify developed the service to ensure viability within a prison. Prisoners are able to access the service 24/7 from their in-cell devices. To ensure prisoner safety and access to emergency services when using SHOUT, we developed an Active Rescue Standard Operating Procedure (building on the established MET police process). Through this process, for anybody displaying signs of crisis, an emergency call is placed to the prison to initiate an in-person welfare check on the individual. Due to the success of SHOUT, the pilot has been extended to additional prisons and is now offered to our staff for additional mental health support.

Staffordshire Training Hub
Staffordshire GPN Foundation School

General Practice Nursing, a cornerstone of Primary Care since its inception in 1966, has evolved into a pivotal profession delivering intricate patient care, highlighted in the Sonnet Report (2022). Key challenges of recruitment and retention of General Practice Nurses (GPNs):- inadequate support for new entrants- ageing workforce; over 47% of GPNs (Staffordshire) over 50 years old. (Evidence 1.1- workforce trends / headcount / age group demographics).- nurses lacking GPN experience to secure nursing positions, as practices prioritise experienced GPNs. At inception, no standardised training pathways were available for new GPNs. Staffordshire GPN Foundation School (GPNFS) founded in 2023, provides an innovative approach to revolutionise GPN training producing a gold-standard approach to GPN education. Engagement was a key requirement to gain support from various stakeholders including healthcare organisations, educational institutions, and professional bodies. Nurse leadership played a pivotal role in driving engagement. Previously, various short term initiatives have been undertaken to address GPN recruitment, but all seen as an unsustainable model reliant on adhoc project funding. The GPNFS stands out for its innovative approach, consolidating the best practices to revolutionise GPN education and training. (Evidence 1.2 - Animation slide). In 2023, the GPNFS successfully attracted 63 applicants through its centralised employer model, ensuring a rigorous selection process to identify the most suitable candidates. A proof-of-concept model, the GPNFS promotes essential changes to safeguard and enhance the GPN role, ultimately ensuring safe and competent service delivery in Primary Care, but also supporting the core capability framework and nursing career pathway with future plans to include the nursing associate roles.Our future plans aspire to both a regional and national rollout of the GPNFS with the overarching vision of establishing a GPN Deanery to further standardise and professionalise GPN education and training, evidenced and supported by the QNI formal evaluation.

Suffolk GP Federation
The Very Important Invitation Project

This project was initially set up with the aim to increase the uptake of cervical screening across Suffolk. General practice data suggested that most practices across the county were achieving between 74%-77% coverage of cervical screening uptake. We developed a training package for primary care whereby we produced two training sessions. One aimed at reception/admin/care navigator staff and one session for practice nurses or clinical members of staff who undertake cervical screening as part of their job role. Alongside this, we created a working tool kit for practice staff to be able to refer back to if and when needed. We recognised the importance for practices to achieve their 80% coverage targets but this made us want to look further into the 20% of the non attenders to see whether there was any outreach work which could be done in the community. This allowed us to hone our primary care education package to have a particular focus on health inequalities and to raise awareness of underserved communities by reducing barriers. Further to our support for primary care, we started networking and building relationships within the VCFSE sector. In particular, organisations supporting the LGBT+ community, local churches covering different faith communities, people with learning disabilities, physical disabilities and/or serious mental health issues, the travelling community, people from black, asian and mixed ethnic backgrounds, those living through deprivation and/or homelessness and people who have a history of abuse or trauma. This allowed us to be able to provide health promotion and education sessions as well as tailored support in accessing cervical screening to individuals most at risk of health inequality. Further to this the project also provides education sessions to secondary schools about HPV and cervical screening awareness as the research points to early education being paramount.

West Road Medical Centre
Primary care partnerships

The aim of the project was to build relationships with local services, to support those who may have issues accessing primary care in an attempt to reduce inequalities in health. The barriers included those who do not have English as their first language, mental health issues, learning disabilities, homelessness, asylum seekers and those living in poverty. I linked in with local services to reach target groups, offering opportunity for empowerment through health education. I signposting to other services including social prescribing, weight management, smoking cessation, mental health services, physio, diagnostic hubs, primary care, secondary care. I helped people navigate the NHS and learned more about difficulties accessing primary care services. It was challenging to find time to link with other groups. I arranged to do a family fun day with a local charity called Riverside but it got cancelled due to poor weather. I made links with Connected Voice but I never got the chance to offer education sessions as my project day was a Friday, when many religious groups visit the mosque. The local foodbank became the focus of the project recognising the benefit of a nurse offering 'a one stop health drop in for all.' I supported clients with respiratory disease, diabetes, raynauds, new cancer diagnosis, MSK issues, women’s health, children’s health and immunisation, smoking cessation, mental health, acute conditions, missed hospital appointments, previous hospital admissions, prescription issues and education on primary care services work. Signposting to other services meant patients could access services without waiting weeks to see a GP first. My futures plans include weekend clinics at the surgery for foodbank users, targeted education sessions as I have plans to role out other health education sessions in the community. I would like to start with asthma education sessions in school for teachers, parents and pupils.