Guidance

The Nursing Team

General practice nursing (GPN) teams  are a key component of the general practice and primary care workforce. Every member of the nursing team has a vital role in delivering care and treatment across the life course.

The following are examples of roles that you may find in primary care, that make up the nursing team-

 

General Practice Nurses

Practice nurses work in GP surgeries where they plan, provide care, treatment, and health education to patients of all ages.

Aspects of the role include-

  • Obtaining blood samples
  • Electrocardiograms (ECGs)
  • Minor and complex wound management including leg ulcers
  • Travel health advice and vaccinations
  • Child immunisations and advice
  • Family planning & women’s health including cervical smears
  • Men’s health screening
  • Sexual health services
  • Smoking cessation
  • Screening and helping patients to manage long term conditions

Nurses working in General Practice are undertaking an ever-wider range of roles, with experienced nurses assuming more of the traditional workload of GPs. For nurses working in primary care, this should be seen as a positive development: for those seeking a challenging and rewarding nursing career, General Practice can offer this. The role allows nurses to develop long term relationships with individuals and families, managing their conditions and improving physical and mental health and wellbeing. ( The Queen’s Nursing Institute ) 

Training and Development

You must be a qualified and registered adult, child, mental health or learning disability nurse to work in general practice. You’ll also either need to undertake further training and education or be willing to after being appointed. More information on the role, skills, training and development can be found here

The CQC advise that 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. 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 is an option for nurses new to general practice and will provide the required theoretical knowledge. This knowledge must be supported with supervised practice in the practical setting. More information on training and career development can be found via your local training hub

The QNI have released a General-Practice-Nursing-Induction-Template designed to provide a consistent and comprehensive system, ensuring that all newly qualified GPNs who are new to primary care receive an effective period of induction that assists supports them to become confident and competent in their new career. 

General Practice Fellowship Scheme

NHS England describes this as ‘a two-year programme of support, available to all newly qualified GPs and nurses working substantively in general practice, with an explicit focus on working within and across a Primary Care Network (PCN). Integrated care systems (ICSs) should encourage all eligible clinicians to sign up and aim for as close to 100% coverage as possible.

The programme offers support with PCN portfolio working and learning and development post-registration, supporting nurses and GPs to take up substantive roles, understand the context they are working in and become embedded in the PCN, as well as increase and maintain high levels of participation in the primary care workforce.

Participants could receive funded mentorship and funded CPD opportunities of one session per week (pro rata), and rotational placements within or across PCNs to develop experience and support transition into the workforce’.

The eligibility criteria for the scheme has now been expanded to include nurses new to general practice. The inclusion of new to general practice nurses will provide support to accelerate their clinical and professional development in primary care, further incentivise this career route and support those more experienced nurses to transition, ensuring these professionals feel valued and are best able to contribute to the wider workforce. Nurses that are interested should discuss with their practice manager or their local training hub

Career Progression

You could specialise in health promotion, chronic disease management, such as diabetes or respiratory care. With experience and qualifications, you could become a nurse practitioner, managing your own caseload of patients. You could also move into management, teaching, or research.

Further information on advanced clinical practice progression can be found here.

The HEE- Primary Care and General Practice Nursing Career and Core Capabilities Framework sets a standard and offers the opportunity for nurses at all levels to develop and evidence their knowledge and skills, enabling the highest standards of practice as well as providing a structure for career and role development within primary care. Watch video on the framework  here

 

NHS Knowledge and Library Services has produced a quick reference guide for nurses and midwives, in community and in GP practice teams There is support for nurses right through their career, offering support to develop, stay up to date, make decisions and give patients the best care possible.

 

 

Further CPD / Revalidation requirements and professional governance

More information can be found here:

Wessex LMCS – Accountability and Delegation

Wessex LMCs – Appraisals and Revalidation

Wessex LMCs – Clinical Supervision

NMC – (Nursing and Midwifery Council)

Further information

GP mythbuster 26: General practice nurses – Care Quality Commission (cqc.org.uk)

Microsoft Word – Nurses in general practice_Summary_FINAL DRAFT v1 (sonnetimpact.co.uk)

future-nurse-proficiencies.pdf (nmc.org.uk)

Registered Nurse Degree Apprenticeship – Resources – HASO (skillsforhealth.org.uk)

Join the RCN | Membership | Royal College of Nursing

The Nursing & Midwifery Council – The Nursing and Midwifery Council (nmc.org.uk)

General practice nursing | Health Education England (hee.nhs.uk)

Video resources

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Nursing Associates

A Nursing Associate is:

            • registered by the Nursing and Midwifery Council and has a PIN number NMC (England only)
            • educated to foundation degree level
            • is accountable for their own practice under the NMC code
            • when registered can undertake continuous professional development to extend their role to suit their working environment
            • must revalidate with the NMC every three years
            • works under supervision of a registered HCP included in the TDDI list (4a)

Please click  here to view –Introducing the nurse associate video.

The Nursing Associate is a support role developed in England in 2017, that bridges the gap between healthcare support workers and graduate registered nurses to deliver hands-on, person-centred care as part of the nursing team in a variety of health and social care settings. Nursing associates are trained to a foundation degree level and  work with people of all ages in a variety of settings in health and social care (hee.nhs.uk) . Following successful completion of the programme, nursing associates are now registered with the NMC.

The NMC has developed and published Standards for nursing associates  which serve a number of purposes-

  • Help nursing associates by providing clarity about their role. 
  • Providing clarity on what knowledge and skills other health and care professionals can reasonably expect from nursing associates. 
  • Allow education institutions to develop and deliver programmes that give students the skills, knowledge, and behaviours to meet these standards when they qualify. 

The role of the Nurse Associate is a vital part of the wider health care team and can-

Trainee Nurse Associate Role / Career progression

Funding for nursing associates (Primary Care Bulletin: Issue 264: 9th November 2023

Trainee nursing associates (TNA) places are available to staff in general practice and primary care networks. Financial support includes £8,000 employer grant per TNA and Apprenticeships levy funding up to £15,000. Send expressions of interest to england.nationalnursingteam@nhs.net.

Nursing Associate training offers a career development opportunity. Many current employed general practice Health Care Assistants (HCAs) are keen to embark on Nursing Associate training. Trainee Nursing Associates in general practice settings report that their new underpinning knowledge is hugely beneficial to their existing task-orientated skill set.  For more information on Nurse associate training click here

More information about the Level 5 Nurse Associate (NMC 2018) apprenticeship training course can be found here- Nursing associate (NMC 2018) (level 5) – apprenticeship training course (education.gov.uk)

Qualified nurse associate now have the option to progress to a nursing programme to become a registered nurse after completion of an 18-month bridging course, more information can be found via your local training hub 

Nurse Associates – further training & capabilities relative to Primary Care

“With continued professional development, Nursing Associates will provide additional capacity within the nursing team. This might be in areas such as contributing to cervical cytology screening, meeting quality and outcomes framework targets and management of long-term conditions. Having additional capacity to meet patient need will be a welcome addition to the team. Supporting development of a Nursing Associate provides an opportunity to shape and mould an individual to fit into a developing team” Nursing-Associates-in-Primary-Care 

Click on the image for a table outlining the further training and capabilities of the RNA in practice.

 

 

Nurse Associates and Travel Health Care

Recently updated May 2023 the RCN guidance on “Competencies: Travel health nursing: career and competence development”, confirms that Registered Nurse Associates are now able to provide a travel health service-

Who can deliver travel health care?

Travel health care can be delivered by registered health care practitioners who are appropriately trained and demonstrate competence in this field of practice. Nursing associates became registrants under the NMC in January 2019 (NMC, 2018b), so since the last review of this publication, they became a new group of nurses who could deliver travel health services. Currently, there are certain prescribing obstacles for the administration of travel vaccines for this particular group that need to be taken into consideration as explained under the ‘Prescribing, supplying and administering travel vaccines’ section on pages 16-17

Taken from page 12 of the RCN document. 

Useful Links and Publications

Employer guide to apprenticeships (publishing.service.gov.uk)

BSW Training Hub – Nursing

CQC –  Briefing for providers: Nursing Associates

Dorset Primary Care Training HubNursing Associate

Nursing associates Frequently asked questions (FAQs) for employers.pdf (hee.nhs.uk)

Nursing Associate Case Studies

Nursing Associates: Their role in General Practice

Overview on the NA Role – Nov 2021

Standards of proficiency for nursing associates

NMC -What is a nursing associate? 

RCN – Becoming a nursing associate

The Role of Nursing Associates in Vaccination and Immunisation

Nursing Associates, Physician Associates and the use of Patient Group Directions

Employer Guide to Nursing Associates

What is a nursing associate? | NHS Employers

RCN Travel Health Nursing: career and competence development | Publications | Royal College of Nursing

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Health Care Assistants (HCAs)

 

Healthcare Assistants (HCAs) and Assistant Practitioners (APs) are a vital part of the nursing team, click Here to watch a video on ‘A day in the life of an HCA working in a GP practice’.

 

 

Role Summary:
  • To support the practice nursing team in the delivery of nursing services, working as part of the practice multidisciplinary team, delivering care within their scope of practice to the entitled patient population.
  • The healthcare assistant will deliver and assist clinical staff in the provision of treatment, preventative care, health promotion and patient education. 

Primary Responsibilities:

  • Undertake new patient health checks.
  • Support the practice nurse with health promotion programmes.
  • Carry out baseline observations such as pulse oximetry, blood pressure, temperature, pulse rate, recording findings accurately.
  • Facilitate routine and 24-hour BP monitoring, advising patients accordingly.
  • Undertake wound care, dressings and other clinical tasks as required.
  • Support the practice nurse with the management of chronic disease clinics.
  • Carry out BMI checks as directed.
  • Act as a chaperone as required.
  • When trained, administer flu vaccinations.
  • Ensure specimens are recorded and ready for onward transportation.
  • Provide support during minor operations as required.
  • Ensure all clinical rooms are adequately stocked and prepared for each session.
  • Ensure fridges are cleaned routinely in accordance with extant guidance.
  • Ensure clinical waste is removed from clinical areas and sharps bins replaced in accordance with the practice IPC policy.
  • Deliver opportunistic health promotion where appropriate.

More information about role can be found Here

The Role of the HCA in General Practice Podcast

In this podcast our Nurse Advisor Zoe Tobin is joined by Julia O Mara and Julia Judd, trainers from J2S training, who provide valuable comprehensive training for HCAs in general practice for Wessex LMCs, to discuss the role of the HCA in general practice and will cover-

  • Overview of the HCA role and role development
  • Clinical supervision / Accountability and Delegation
  • Extended roles, such as Long-term conditions management
  • Tips for CPD and what to look for when employing a HCA
  • Key resources and support for HCAs.

This podcast would be beneficial for any current HCAs, or anyone interested in the role, it is also beneficial for employers / managers who would like to find out more about the role in practice.

Listen to the podcast here

Long term conditions monitoring:

In some practices senior HCAs are actively involved in long-term conditions monitoring, for example diabetes care for patients e.g., taking basis measurements, pre visit bloods and health education and undertaking simple asthma reviews, under clinical supervision of a registered competent professional. They provide an important role in supporting the patient, carer/s and the wider practice team.

It is recommended that you have undertaken the necessary training and education to undertake this role, can provide evidence of competency and understanding and receive regular supervision with ongoing CPD.

Wessex LMCs provide an Introduction to Diabetes for HCAs course and a 3-day respiratory course suitable for experienced / level 3 trained HCAs, more information can be found here- Wessex LMCs: Upcoming Events

Legal Responsibility / Accountability

Code of Conduct for HCSW & ASCW in England (2013)

The Code describes the standards of conduct, behaviour and attitude that the public and people who use health and care services should expect. You are responsible for, and have a duty of care to ensure that your conduct does not fall below the standards detailed in the Code. Nothing that you do, or omit to do, should harm the safety and wellbeing of people who use health and care services, and the public.

Skillsforcare

 

According to the CQC –‘HCAs have a duty of care and a legal responsibility to the patients they see. HCAs are not registered with a professional body. They are accountable to their employer to follow their contract of employment. Employers have a responsibility to train, supervise and have oversight of their HCAs. This is until the competence of the HCA can be shown.

Employers accept vicarious liability for their employees. They are accountable for the actions and omissions of the employee. It is vital that employers make sure employees only work within the limits of their competence. If a registered nurse is responsible for delegating tasks to an HCA, the registered nurse is responsible under the Nursing and Midwifery Council (NMC) Code of Conduct for the safe delegation of that task.

Regardless of the task being undertaken, the principles of delegation remain the same:

  • HCAs should be trained and assessed as competent.
  • the HCA’s job description should specify their role.
  • the practice should make sure they have appropriate medical indemnity for the HCAs they employ. The cover provided should be enough to cover their scope of practice.
  • There should be clear guidelines and protocols in place. The support worker is not required to make a standalone clinical judgement.

The potential isolation of the primary care environment presents different challenges for HCAs. They may have previously worked within larger teams in social care or hospitals. The scope and nature of the HCA’s responsibilities vary between practices. They depend on the individual needs of the practice.

In general practice, HCAs will be carrying out care for patients independently. They should have access to a registered nurse or GP for advice and support when needed. The level of supervision needed will depend on the task being undertaken. The degree of risk must have been assessed. The patient has a right to the same standard of care, whoever delivers it’. 

Administration of vaccines;

According to the CQC

‘The RCN supports HCAs to administer specific vaccines to adults and the nasal influenza vaccine to children. This is only if they are appropriately trained and have the support of a registered health care professional. For example, a GP or nurse in primary care. The RCN does not support HCAs administering other vaccines. These include the remainder of the childhood vaccination programme or travel vaccines. This is due to the clinical decision-making involved.

In all cases, Patient Specific Directions (PSD) should be in place. A PSD is a specific, written order by a qualified prescriber. The prescriber retains responsibility for safe administration of the vaccine’.

More information can be found here-

RCN guidance for HCSW administering inactivated influenza, shingles, pneumococcal vaccines for adults and Live Attenuated Influenza for children

Main heading (publishing.service.gov.uk)

Patient Specific Directions (PSD) – SPS – Specialist Pharmacy Service – The first stop for professional medicines advice

RCN membership

Although HCAs are not registered with a professional body, the RCN state that ‘As the world’s largest nursing trade union and professional body, we are here to support the whole of the nursing workforce.

Health care assistants, assistant practitioners, health care support workers, nursing associates and trainee nursing associates, join today and together we can make the voice of nursing stronger’

More information on membership can be found here 

Training and Development

Also see our page HCA Training Standards

‘Training as a healthcare assistant will include basic nursing skills and you’ll work towards the Care Certificate, developed by Skills for CareSkills for Health and Health Education England and launched in 2015.

Find out more about the Care Certificate

You may also be offered the chance to study for qualifications through an apprenticeship such as:

  •  level 2 Certificate – Healthcare Support Worker
  • Level 3- Senior Healthcare Support Worker 

More information about apprenticeships can be found here-

Healthcare support worker (level 2) – apprenticeship training course (education.gov.uk)

Senior healthcare support worker (level 3) – apprenticeship training course (education.gov.uk) 

With experience and further training, you could become a senior healthcare assistant. You could then apply to train as an assistant practitioner or nursing associate. With the appropriate qualifications/evidence of academic ability, you could also train as one of the many degree-level healthcare professionals such as a nurse, podiatrist, midwife, or occupational therapist’.

The above has been taken from- Healthcare assistant | Health Careers

For further information on career progression please see the Trainee Nurse Associate section above and for information on an alternative pathway, the Level 6 Registered Nurse degree (NMC,2018) apprenticeship can be found here- Registered nurse degree (NMC 2018) (level 6) – apprenticeship training course (education.gov.uk) 

Further Training & Education Resources and Useful Information 

BSW training hubHealthcare Assistant – bswtraininghub.nhs.uk

Dorset training hub- Apprenticeships – Dorset Primary Care Training Hub (primarycaredorset.co.uk)

HIOW training hub- Working across Wessex (hee.nhs.uk)

Frimley training hub-  Health Care Assistant – Frimley Training Hub

Code of Conduct (skillsforcare.org.uk)

Health Care Assistants in General Practice – Care Quality Commission (cqc.org.uk)

National Minimum Standards and Core Curriculum for Immunisation Training of Healthcare Support Workers

Patient Group Directions (PGDs)/Patient Specific Directions (PSDs) – Care Quality Commission (cqc.org.uk)

Patient Specific Directions (PSD) – SPS – Specialist Pharmacy Service – The first stop for professional medicines advice

Care Certificate – eLearning for Healthcare (e-lfh.org.uk)

Wessex LMCs: Education, Training & Development– we offer a range of training courses for HCA’s, including a 2.5 day course ‘Clinical skills portfolio for Health Care Assistants’.

Healthcare Support Worker | Health Practitioner Career Pathways | Careers Resources | Royal College of Nursing (rcn.org.uk)

Care Certificate (skillsforcare.org.uk)

Healthcare assistant | Health Careers

The Health Care Assistant Preceptorship Framework for Induction into General Practice.

 

Please click on the image to access an example of an HCA preceptorship framework. (Special thanks to Julia O’Mara Nurse Advisor at Portsmouth ICB)

 

 

 

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Advanced Nurse Practitioners (ANPs)

Advanced practice is a level of practice, rather than a type of practice. Advanced Nurse Practitioners are educated at master’s Level in clinical practice and have been assessed as competent in practice using their expert clinical knowledge and skills. They have the freedom and authority to act, making autonomous decisions in the assessment, diagnosis, and treatment of patients. RCN

Registered nurses working at this advanced level must meet the following standards . They must:

  • have an active registration with the NMC
  • practice within the four pillars
  • have a Job Plan that demonstrates advanced nursing practice and has equity with peers working at this level
  • be educated to Masters level
  • be an independent prescriber
  • meet NMC revalidation requirements
  • demonstrate autonomous evidence

See: Royal College of Nursing Standards for Advanced Level Nursing Practice

The CQC describe that the Advanced Nurse Practitioner means a nurse with Level 7 MSc qualifications in clinical assessment. This includes:

  • history taking
  • physical examination and
  • independent prescribing

The ANP Role

ANPs can:

  • prescribe any medicine for any condition within their competence (including some controlled medicines) provided they have completed an Independent Prescribing qualification.
  • see patients with undiagnosed, undifferentiated medical conditions and make treatment decisions, including ordering necessary investigations.
  • refer patients to secondary care, although this can vary depending on local arrangements and protocols.
  • undertake appropriate home visits.
  • sign fit notes.

The NMC states that only a registered medical practitioner or a practicing midwife can provide assessments and pregnancy related care for a pregnant woman, more info can be found here .

 

According to the CQC ANPs ‘can safely work in a first contact role to manage patients who present with a range of symptoms not previously assessed by another appropriate Health Care Professional. Nurses working at an advanced level can be employed in roles such as the ANP. They must show capability against the Core Capabilities Framework for Advanced Clinical Practice (Nurses) Working in General Practice / Primary Care in England

This framework provides a standard and greater clarity on the capabilities for nurses working at the advanced clinical practice level within general practice.

The framework comprises 4 Domains. Within the Domains, 13 Capabilities describes the skills, knowledge and behaviours required for nurses working at the advanced clinical practice level. The Capabilities are underpinned by core indicative knowledge, key clinical presentations, investigations, and referrals.

This framework aligns with the requirements for clinical practice set out in the multi-professional framework for advanced clinical practice in England  (HEE 2017).

Skills for Health

Non- medical prescriber guidance

According to the CQC:

Non-medical prescribers can be either independent or supplementary prescribers. An independent prescriber is able to prescribe, on their own initiative, any medicine within their scope of practice and relevant legislation.

Non-medical prescribers must:

  • be registered with the appropriate professional regulator.
  • have their prescribing qualification annotated on the register.

To gain this, they must undertake an accredited non-medical prescribing programme at a higher education institution. These programmes provide the knowledge, skills and training to prescribe safely and competently.

Non-medical prescribers should work to the Royal Pharmaceutical Society’s Competency Framework for All Prescribers . They should not prescribe outside their competency. Practices should have systems to make sure they are working within the limits of their competency.

Practices must also provide staff with appropriate supervision and allocate an appropriate senior member of the primary care team to provide day-to-day supervision of all clinical staff. Health Education England has published guidance for employers on Workplace Supervision for Advanced Clinical Practice. The Health and Care Professions Council has also published guidance for allied health professionals on supervision standards. 

More information around becoming a prescriber and the NMC prescribing standards can be found hereStandards for prescribers – The Nursing and Midwifery Council (nmc.org.uk)

Example of an ANP job description

For more information on Advanced Clinical Practice, please visit our webpage here

Useful resources

Advanced Clinical Practice Nurses Primary Care England | Skills for Health

Advanced practice and enhanced practice | NHS Employers

Advanced advanced-practice-report-final.pdf (nmc.org.uk)practice standards | Royal College of Nursing (rcn.org.uk)

GP mythbuster 66: Advanced Nurse Practitioners (ANPs) in primary care – Care Quality Commission (cqc.org.uk)

Advanced Nurse Practitioner level 8 template.docx (live.com)

multi-professionalframeworkforadvancedclinicalpracticeinengland.pdf (hee.nhs.uk)

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Last Reviewed Date
08/12/2023