Background
Communities of practice (CoP)
Aims and objectives
Methods
Context for the study
Study design
Cohort and sample
Data collection
Research governance
Data analysis
Results
Theme One: | Sub-themes: |
---|---|
“Fishing in the same small pond”
| • Succession planning |
• The recruitment ‘merry go round’ | |
• Cultural antecedents | |
• Adapt to survive |
Theme Two: | Sub-themes: |
---|---|
“Growing your own staff”
| • The need for ‘new blood’ |
• The need for some fine tuning | |
• Investing in the future workforce | |
• Green shoots of cultural change |
Fishing in the same small pond
Succession planning
"… there are lots of GPs round here who are coming up to retirement, and they have all got practice nurses that are coming up to retirement too …"
"We had some real difficulty filling that last vacancy … we've got a number of people [GPNs] approaching retirement and that gives us an opportunity to perhaps do things a bit differently next time …"
"I think [the] hospital nurses want to come into primary care because it's a Monday to Friday nine-to-five job … they've done a few years in hospital with shifts and nights and everything else, seven days a week and then they start thinking, actually, I quite fancy a job that's a bit more family-friendly. It's not always … 'I really want to work in primary care'…"
The recruitment ‘merry go round’
"There's going to be a much greater demand for practice nurses and particularly the more highly skilled ones that can manage their own caseload …"
"I do understand that we are poaching them [GPNs] from each other … You know, obviously, there’s not enough nurses around (sic) and it does seem to me they just swap from one practice to another … "
"They just poach from other practices, but [even] that’s dried up now … they’ve been taking from secondary care too … So we're all just fishing in the same small pond, aren’t we?"
Cultural antecedents
"We've had to work hard to get an understanding from some of the GPs and from quite a lot of university teachers and from quite a lot of student nurses too that they [nurses] do not* need secondary care experience before they go into primary care ... and that’s the problem"* Denotes heavy emphasis placed on these words by respondent
"I don’t know how many of the students will actually try and get into general practice… most of them go into the hospitals [when they qualify] as that’s where they have all their training…"
This then became a self-fulfilling prophesy in which GPs did not actively seek to recruit new graduate nurses, and new graduate nurses did not apply for GPN posts. However, the findings from another component of this evaluation [20] indicated that the students with general practice placements were beginning to appreciate the role of the GPN and the opportunities that it provided. The prospect of working in general practice upon graduation was now seen as attractive to many of them." … They all seem to think that working in a hospital is sexier (sic) than working in a GP surgery …"
Adapt to survive
"I mean … 'traditional' general practice needs to adapt … previously you had say five or six GPs, a couple of nurses and one HCA [in a practice] but the skill mix is not needed like that anymore … "
The development of non-medical staff within general practice has been ad hoc and informal, and this has meant that the infrastructure required for sustainable workforce change has not been a priority. The accelerated expansion of non-medical roles in more recent times has resulted in a ‘patchwork’ of different roles and different titles. The introduction of the ACP role is a good example of this. The title of ACP is not regulated in the same way as the title of GP, but an ACP is generally considered to be a fully autonomous practitioner, educated to Masters Level, managing their own caseload in the same way as the GP."… there are some practices who are already beginning to change, so they'll have three GPs, four or five nurses, of which three will prescribe and one's an ACP [Advanced Clinical Practitioner], and five or six HCAs"
"What you don't want is loads of other people's 'baggage', which you generally get with somebody who's come from somewhere else … 'we don't do it that way; I do it this way'… far better then, to recruit newly qualifieds (sic) and 'grow your own'?"
Growing your own staff
" … GPs need to understand that if they want a new nurse, they can either try and poach one off [the] 'roundabout', which just recycles what's there, does nothing for the gene pool or they can take somebody straight from training … and train them up themselves …"
"I suppose they’ll not come with any of the preconceived ideas of, you know, 'this happens in the practice that I used to work in before'… from the beginning you’re teaching them how you want it to work here from the very start. I think that’s got to be a good thing…"
"We’ve got to encourage the younger generation… I think we’ve got this fixed idea of what practice nurses are, and we think of the 'old school' nurses and so many things have changed now… So I think we would encourage new young nurses to come in…"
"I think there are several advantages [to the ATPS] having somebody helps you keep up to date […] that also helps the practice […] It gives a different perspective because the nurses that are training are doing other things […] so they’ve got a slightly different angle on things..."
"I think they [the student nurses] bring a fresh and different outlook, different skills too… I would hope that we’d be able to develop them and they'd stay… like I say it’s growing your own isn't it..?"
It's a win-win situation [the ATPS]. If they like the practice and you like them, then you know they're coming up… that's what we do with the [GP] trainees. I mean most of the partners here have been ex-trainees in this practice because it's much better to recruit someone you know who's worked here. And they know what you're like so it's about getting the right fit, isn’t it?"
The need for some ‘fine tuning’
"We are trying to address it [the shortage of GPNs]. We're taking student nurses now and that's great. But they only came for like a six week block in a three-year training programme. It's not enough. We need them for longer but I don’t know how we would get around that […] I think they do need more exposure to primary care…"
"Realistically, if you really wanted grow your own, you would have them in the first year, then the second year and then you would have them back in the third year, back to you at your practice, and then you'd offer them a job at the end of it. That’s where this [ATPS] would come in…"
"It needs to be a proper partnership between you [the HEIs] and us then we all benefit don't we? I don't think we understand enough [about each other] but having them [the students] helps…"
Investing in the future workforce
"… I think there’s perhaps a worry that somebody at that [early] stage of their career is more likely to be looking for the next job…"
"The younger ones… they'll all want full time hours… you are going to get [some] smaller practices who don't always need full-time nurses… then what?"
"We'd have to think… 'what would that enable them to do and does it fit with what we want them to do?'…"
"We're a business in the same way everyone else is (sic) and therefore it's not like a hospital… you're not going to train someone at your own cost are you?"
This seems to relate to a largely unfounded perception that, once trained, the GPNs would simply ‘follow the money’. Whilst some of the GPNs were clearly ‘economically mobile’, the vast majority of the GPNs were viewed as being driven by the perceived quality of their terms and conditions rather than purely by financial concerns."… it would be a disincentive to encourage increasing training (sic) if you think that somebody who’s better trained might get poached by another practice in order to get a pay rise…"
Green shoots of cultural change
"…This [ATPS] has been a massive but necessary change when you think that general practices are still, the majority, are very much 'corner shops' all doing their own thing…"
"… I think in the future you're going to get practices working together to employ nurses to meet the demand. It will have to happen … but they may have to work across practices…"
"What's next then? Well, in my mind the [long term] plan would be to make the ATPS, now they're well-established, to make them proper educational hubs for doctors and nurses alike …"