Transition To General Practice Nursing (Inglés) Autor Agnes Fanning y Zoe Berry

Transition to
General
Practice
Nursing
Contents
Section A - Thinking about
working in primary care
Chapter 1 - What is General Practice
Nursing?
Chapter 2 - Making the transition
from hospital to primary care
Section B - Working in
General Practice
Chapter 3 - Working safely
Chapter 4 - Patient focus
Chapter 5 - Mid point reflection and
progress check on identified skills
development
Chapter 6 - Team working and
working with other professionals
Chapter 7 - Working with vulnerable
groups
Chapter 8 - Carer support
Section C - The future -

personal and professional
development
Chapter 9 - The policy context and
keeping up to date
Chapter 10 - Developing your career
in General Practice Nursing
Section A - Thinking about working in primary
care
Chapter 1 - What is General Practice Nursing?
Introduction
The aim of this Chapter is to:
• Provide you with a brief overview of the history of General Practice

Nursing in the UK.
• Consider how some of the perceptions of General Practice Nursing
reflect the historic development of the role
• Outline the different roles and responsibilities of professionals in
the primary care setting
• Consider what skills you may need to work in the primary care
setting
Historical Perspectives
General Practice Nursing is a rapidly expanding speciality in nursing,
reflecting the shift in health care delivery from secondary to primary
care over the last two decades. Initially nurses were said to be attracted
to working within General Practice because of the regular hours and
flexibility offered because it tended not to involve shift work. Increasingly
it is because of the ability to work with individuals and families and to
take on a variety of roles and responsibilities.
Following the formation of the NHS in 1948, General Practitioners were

appointed as independent contractors and ‘gatekeepers’ of access
to health care. They have been responsible for delivering primary and
personal medical care to all those patients registered with them ever
since. It was not until 1966 that the first contract between General
Practitioners (GPs) and the National Health Service (NHS) was drawn
up and funding for ancillary staff, including nurses, was made available.
In the very early days nurses were generally employed to work in
treatment rooms, carrying out basic nursing care tasks such as weighing
patients, testing urine, taking specimens, doing dressings and giving
injections and observations such as temperature and pulse (Cartwright
and Scott 1961).
The limited range of duties of the General Practice Nurse (GPN) at this
time would have been unlikely to exceed the competencies expected of
any registered general nurse. This perception, that GPNs were unlikely
to require further post registration training or education to fulfil the role,
generally persisted up until the late 1980s. With subsequent changes
to the contracts that GPs have held with the NHS to provide General
Medical Services, both in 1990 and 2004, a greater emphasis has been
put on the role of GPNs in the management of long term conditions
(LTCs) such as diabetes, asthma and chronic obstructive pulmonary
disease and in health promotion. This has resulted in the requirement
for specific additional training for nurses working in General Practice.
The public attitude towards GPNs may reflect traditional attitudes

towards community nurses such as District Nurses due to the nature
of the care that they perform. Community nurses have traditionally had
to be creative in the way in which they practice and deliver care in
the home setting. They are renowned for being able to ‘think on their
‘This perception that GPNs were unlikely to require further post
registration training or education generally persisted to the 1980s.’
feet’: to adapt to situations and be resourceful in Definition of a General Practice Nurse
unpredictable surrounding and situations QNI (2008). General Practice Nurses work as part of a Multi-
Similarly GPNs have responded to a rapid expansion Disciplinary Team (MDT) within GP surgeries and
in their role by developing skills, gaining knowledge assess, screen and treat patients of all ages. In addition
and maintaining informal networks to disseminate to providing traditional aspects of nursing care such
good practice. The Royal College of Nursing as wound care, immunisations and administration
(RCN) practice nurse forum lobbied for specialist of medicines, they run clinics for patients with Long
practitioner recognition from the United Kingdom Term Conditions such as asthma, heart disease and
Central Council (UKCC) and this was achieved in diabetes. They also offer health promotion advice in
1994 (UKCC 1994); however this did not result in a areas such as contraception, weight loss, smoking
recognised qualification. cessation and travel immunisations.
In addition to their role in the management of Role of general practice nurse

LTCs and in the treatment room, nurses in general
practice have developed skills in the management of
patients with undifferentiated diagnoses and those PATIENT FOCUS
requiring unscheduled or urgent care. This has led to • Therapeutic relationships
• Patient advocate
the development of Advanced Practice Nurses and • Carers support
Advanced Nurse Practitioners reflecting the diversity MANAGEMENT • Self-management COLLABORATIVE
• Evaluation and review • Inter-professional working
of opportunities available. The DH Advanced Practice • Organisational skills • Complex care co-ordinator
• Caseload
Position Statement (2010) outlines the key element • Care management
•
•
Referral
Written and verbal skills
of Advanced Practice which include prescribing and •
•
Emotional labour
Resources
• Technology
referral. • Business acumen

General SKILLS
www.gov.uk/government/uploads/system/uploads/ EDUCATION & KNOWLEDGE Practice • Holistic assessment
attachment_data/file/215935/dh_121738.pdf • Graduate/Masters level Nurse • Clinical decision making
workforce • Clinical skills
• National and local policy • Communication
The introduction of Health Care Assistants (HCA) • Needs assessment • Curative
• Maintenance
to the Multidisciplinary Team (MDT) within general • Strategy
• Palliative
• Evidence-based practice
practice has contributed to this diversification. The role • LTCs
LEADERSHIP
• Role identity
of the HCA in General Practice tends to involve tasks • Health promotion/
improvement • Team Leader/Staff Manage-
such as simple dressings and the administration of ment
• Mentor
injections under Patient Group Directives, but is still • Visionary
relatively new and varies from practice to practice. • Autonomy
Figure 1. Created by Sharon Aldridge-

Bent (2012)
The Shape of Caring review (2015) chaired by Lord
Willis outlines its intention to improve the capabilities
of Health and Social Care Assistants and for Health The Future
Education England (HEE) to promote structured The Health and Social Care Act (2012) primary care
career development for these increasingly important saw the introduction of Clinical Commissioning
members of the workforce. The introduction of Groups led by GPs responsible for the commissioning
the Care Certificate to be completed by all new and delivery of health care. As a result many GP
HCAs during their induction is the first step. The practices are working closely together to redesign
Care Certificate is a first level introduction to the primary care services and consider how the MDT
fundamentals of care and consists of 15 standards might work in different ways.
that are assessed ‘in house’ during the first 12 weeks
of employment. ‘The Five Year Forward View’ (2014) stresses the
need to change the way in which health care is
Below are links to the Shape of Caring Review and to delivered and suggests ways in which health and
further information on the Care Certificate. social care organisations might change. As a result
it is predicted that General Practice Nurses’ and
• http://hee.nhs.uk/wp-content/blogs.dir/321/ community nurses’ roles will continue to change in
files/2015/03/2348-Shape-of-caring-review- response to the demands and challenges presented
FINAL.pdf by an ageing population with complex physical and
mental health needs.
• www.skillsforcare.org .uk/St andards/Care-
Certificate/Care-Certificate.aspx ‘Transition to General Practice Nursing’ - Chapter 1 - p2
It is likely however that nursing in general practice will continue to offer
a diverse range of career options.
Different roles in the community

General Practice Nurses work with a wide range of health and social
care professionals. Trying to identify and establish all the different roles
will seem quite daunting to begin with. Here is a brief overview of the
roles to get you started:
The multi-disciplinary team
Community
Staff Nurse District
Community
Mental Health Nurse
Nurse
Health
SaLT Visitor
School
Physio- General Nurse
therapists
Practice
Nurse
Occupa-
tional Community
Therapists Matron
GPs Nurse
Community Specialist
Learning
Children’s Disability
Nurses
General Practitioners (GPs) - provide a complete spectrum of

care within the local community: dealing with problems that often
combine physical, psychological and social components. Most GPs are
independent contractors to the NHS. This independence means that in
most cases, they are responsible for providing adequate premises from
which to practice and for employing their own staff.
District Nurses - are qualified and registered nurses who undertake

further training and education to become specialist community
practitioners. They visit people in their own homes or in residential care
homes, providing care for patients and supporting family members. As
well providing direct patient care, district nurses also have a teaching
role, working with patients to enable them to care for themselves or
with family members, teaching them how to give care to their relatives.
Health Visitors- also known as a Specialist Community Public Health

Nurse (SCPHN) - Health Visitors work with families with children under
the age of 5 years. They support families and children in issues such as
growth and development, post natal depression, breast feeding and
weaning, domestic violence and bereavement. They also play a role in
safeguarding and protecting children from harm.
School Nurses - also known as a Specialist Community Public Health

Nurse - (SCPHN). School nurses work primarily with children in the
‘There are many specialist nurses working in the community setting.’
school setting. They offer a wide variety of services disabilities. They also offer support to their families.
including health and sex education, development Learning disability nursing is provided in settings
screening, immunisation screening and personal, such as adult education, residential and community
social and health education across primary and centers, as well as in patients’ homes, workplaces
secondary education. and schools.
Community Children’s Nurses - provide holistic Pharmacists - are experts in medicines and work
care to sick children by providing nursing care in the to ensure the safe supply and use of medicines by
community setting, empowering and enabling the the public. Pharmacists register with the General
child, family/carers to become more competent in Pharmaceutical Council (GPhC) following completion
the management of the child’s condition, thereby of a four-year Master of Pharmacy degree from a
reducing the need for hospital admissions or UK school of pharmacy. They then work for at least
enabling early discharge. Community Children’s a year under the supervision of an experienced and
Nurses provide nursing care to children and young qualified pharmacist, either in a hospital or community
people with a life limiting, life threatening condition, pharmacy such as a supermarket or high street
complex disability, long term conditions such as pharmacy. Around 70% of pharmacists work in the
asthma, eczema or allergies as well as palliative and community preparing and dispensing prescription
end of life care. and non-prescription medicines in premises on local
high streets.
Community Matrons - are usually deemed to be
working as advanced nurse practitioners. These Occupational Therapists - work with people of
highly-skilled nurses have a variety of tasks and all ages to help them overcome the effects of
responsibilities, including: carrying out treatment, disability caused by physical or psychological illness,
prescribing medicines, or referring patients to an ageing or accident. The profession offers enormous
appropriate specialist. They plan and provide skilled opportunities for career development and endless
and competent care that meets patients’ health and variety.
social care needs, involving other members of the
healthcare team as appropriate Physiotherapists - A physiotherapist’s core skills
include manual therapy, therapeutic exercise and
Specialist Nurses the application of electro-physical modalities. They
There are many specialist nurses working in the also have an appreciation of psychological, cultural
community setting and they play a key role in the and social factors influencing their clients. Most
management of patient care. Working closely with physiotherapists work in the community and a
doctors and other members of the multidisciplinary growing number are employed by GPs. Treatment
team, they educate and support patients, relatives and advice for patients and carers take place in their
and carers from a variety of specialties e.g. Tissue own homes, nursing homes, day centres, schools
Viability, Palliative Care, Diabetes, Parkinson’s, and health centres.
Continence Advisors and Coronary Heart Disease.
Rapid Response or Integrated Care Teams – are
Community Mental Health Nurses - A Community multidisciplinary health and social care teams made
Mental Health Nurse (CMHN), also sometimes up of physiotherapists, occupational therapists,
known as a Community Psychiatric Nurse, is a support workers and nurses. The service aims to
registered nurse with specialist training in mental prevent unnecessary patient admission to hospital.
health. Some CMHNs are attached to GP surgeries, These teams provide short-term support and
or community mental health centres, while others rehabilitation in the home.
work in psychiatric units. CMHNs have a wide
range of expertise and offer advice and support to Speech and Language Therapists (SaLT) - assess
people with long-term mental health conditions, and and treat speech, language and communication
administer medication. Some CMHNs specialise problems in people of all ages to help them better
in treating certain people, such as children, older communicate. They’ll also work with people who
people, or people with a drug or alcohol addiction. have eating and swallowing problems.
Learning Disability Nurses - provide specialist

healthcare to those with a range of learning
‘Transition to General Practice Nursing’ - Chapter 1 - p4

Exercise
What personal skills are required to work in the community?
In some instances a SWOT analysis is a good way to establish insight

into your own abilities. Take a sheet of paper and divide it into four cells
and label them ‘strengths’ ‘weaknesses’ ‘opportunities’ and ‘threats’.
Under each heading within each cell write down as many things that
you can think of that relate to your role as a nurse. You can then ask
yourself, ‘What are the threats that the weaknesses expose us to?’
and ‘What opportunities arise because of your strengths?’. By doing a
SWOT analysis it allows you to become critical of and to reflect upon
your own behaviour. This can sometimes be a step towards changing
and developing as a result both personally and professionally.
Diagnostic self-assessed identification of leaning needs for

community based practice:
Strengths Weaknesses
Opportunities Threats
Example of a completed SWOT
Strengths Weaknesses
Excellent clinical skills Have not worked in the
Good communication community before
skills Lack confidence
Enthusiastic Worried about additional skills
Like being able to make needed
decisions Not confident to teach others
Lack of knowledge of a wide
range of LTCs
Lack of clinical skills
Opportunities Threats
Working in a team Not sure if primary care nursing is
Change in career pathway for me
Support from my mentor Working on my own
Opportunity to do the course Safety
Making the right decisions
‘When I first moved to the community I wasn’t aware that I would
have so much to learn.’
Having completed your SWOT, it will be clear that you It has challenged you to consider if primary care
possess many transferable skills from your present nursing is for you and also to think about your own
position that can be used in a different setting. It clinical skills and what additional skills you may need
may also allow you to realise that working in the to work in general practice.
community is not for you, or perhaps there are areas
you need to develop before deciding upon a move.
Web Resources
• www.qni.org.uk - The Queen’s Nursing Institute
In a recent QNI (2013) community survey, 58% of
all nurses identified lack of clinical skills as one of
• www.nhscareers.nhs.uk - NHS Careers
their main concerns when starting a career in the
community.
• www.bupa.co.uk/buildingthecase - BUPA
‘When I first moved to the community I wasn’t aware
• w w w. r c n . o r g . u k / d eve l o p m e n t / n u r s i n g _
that I would have so much to learn. I thought that the
communities/rcn_forums/practice_nurses - RCN
skills I had as a qualified nurse would be all I needed-
Oh how wrong I was!’
• www.practicenursing.co.uk - Practice Nurse’s
Association
Exercise
Now consider what additional clinical skills do
• www.rcgp.org.uk/membership/practice-team-
I need to work in General Practice? Make a
resources/~/media/1E0765D171B44849876EA
list of them here:
38FC97E96F1.ashx - RCGP GPN competencies
Additional clinical skills needed may include:
• w w w . r c n . o r g . u k / _ _ d a t a / a s s e t s / p d f _
• Wound and leg ulcer assessment and
file/0003/146478/003207.pdf - RCN ANP
management including: use of Doppler, wound
Competencies
products, compression bandaging.
• Ear irrigation
• www.6cs.england.nhs.uk/pg/cv_content/
• Venepuncture
content/view/149160/129853 - DH Visual
• Management of Long Term Conditions e.g.
diabetes and asthma
• w w w. g o v. u k / g o v e r n m e n t / p u b l i c a t i o n s /
• Childhood immunisations
advanced-level-nursing-a-position-statement
(This list is not exhaustive).
- DH Advanced Nursing Practice position
statement
General Practice Nurses’ Quotes
What do you most enjoy about working in General
Practice?
‘Patient contact - in our practice we do get to know

patients and their families.’
‘Being able to use all of my nurse skills to deal with

acute and chronic presentations.’
‘Helping patients achieve their goals. Optimising care

and encouraging self- management.’
Transition to
Chapter Summary
General
Practice
Nursing
Contents
Nursing?
This Chapter has looked at the history of

General Practice
development
groups
General Practice Nursing in the UK and some

development
keeping up to date
of the public attitudes towards community nurses.

It has identified the distinct role of the General
Practice Nurse and the importance of developing
a clear understanding of all the other health care
professionals that provide care to people in the home.

Transition to
General
Practice
Nursing
Contents
Nursing?
General Practice
development
groups

development
keeping up to date
Section A - Thinking about working in primary
care
Chapter 2 - Making the transition from hospital to
primary care

• Develop an understanding of primary care as a work environment
• Identify the support available to you as a General Practice Nurse and
whilst going through this resource
• Introduce ‘Reflection’ as a learning tool and consider some models
of reflection
• Start to think about how you would like to record your reflections
whilst doing this online resource.
Introduction
When making the transition from the hospital to primary care there are
many practical aspects that may need to be taken into consideration.
General Practices mainly operate as small business units, as most GPs
are independent contractors to the NHS. You may also need to familiarise
yourself with the geographical area to understand the environment in
which your patients live and to begin to understand the profile of your
practice population. One way of doing this may be by spending some
time either walking, cycling or driving around to get your bearings and
to consider some of the below:
Housing
• What type of housing is in the area?
• Is there a mix?
• What condition are the houses in?
Environment
• Cleanliness of the streets / graffiti
• Parks and green spaces
Facilities
• Primary Schools?
• Secondary Schools?
• Are there local shops?
• Is there a pharmacist?
• Is there a supermarket nearby?
• Post Office?
• Where are the local GP Surgeries?
• What District General Hospital serves this area?
• Residential Homes?
• Elderly Day centres?
• Community Centre and Library?
• Location of Local Social Services, chiropody, physiotherapy etc?
Transport
• What public transport is available?
• Are there frequent services?
• What else can you tell about the area?
By doing this fact finding exercise you will develop a wider understanding
of the community in which you are going to be working and this local
‘It will not be your role to make judgements on the way in which
people choose to live their lives.’
knowledge will be invaluable when delivering care to Local Medical Committee (LMC) fund and organise
your patients. Education and Training.
Consider your working environment The wider General Practice team will be key in
Many nurses are attracted to General Practice assisting you to make the transition and at times will
because of the opportunities to work with patients feel like a ‘lifeline’ to assisting you to make the change.
on a one to one basis, often over a prolonged period Effective primary care is built on the foundations of
of time in which significant relationships may be good partnership and team working.
formed.
What support is available in general
You will also be exposed to the way in which many practice?
of your patients may choose to live and this may It is advised that you identify a mentor or facilitator
also influence your relationship and your approach who can support you whilst going through this online
in delivering care. It will not be your role to make resource.
judgements on the way in which people choose to
live their lives. It will require you to apply the same Ideally this person would be a qualified nurse and
anti-discriminatory practice and behaviour that you trained mentor who has had experience of working
would have practiced in other settings. in primary care. Here is the link to the NMC guidance
on standards expected for those supporting learning
This shift in the balance of the relationship cannot and assessment in practice:
be underestimated. You will need to develop skills in www.nmc.org.uk/standards/additional-standards/
managing relationships with patients and carers and standards-to-support-learning-and-assessment-in-
ensuring that these relationships are positive. This practice/
may be achieved by spending time to understand their
individual needs and build a trusting relationship. It The main role of your mentor will be to assist with
will also be about how you advocate for the patients your development, both in terms of making the
you care for. This relationship is unique and will transition to the community setting and identifying
require you to maintain a professional relationship any additional support you may need.
that protects both you and the patient.
Ideally you should try and meet with your mentor
Managing your time weekly to reflect upon your week’s learning and to
Another challenge will be to manage your time get an experienced community nurse’s perspective
effectively when working within appointment on the challenges you may face.
systems. Whilst wanting to spend time building up
a relationship with a patient and their carer which is If you are maintaining a e- reflective journal it may be
vital, you will also need to keep to a schedule and helpful to invite your mentor into your journal so that
balance the time spent with all of your patients. Over he or she can see how you are getting along.
time the experienced GPN can hone the required
consultation skills in order to ensure enough time to You may find it helpful to use nationally agreed GPN
see to all her patient’s needs, whilst keeping to time. competencies to identify areas where you have
gaps in your knowledge or skills. E.g. RCGP GPN
Many nurses new to primary care also highlight the competencies: www.rcgp.org.uk/membership/
isolation they can experience as an autonomous practice-team-resources/~/media/1E0765D171B448
practitioner, having come from a ward environment 49876EA38FC97E96F1.ashx
where there is always someone to talk to and ask
for advice. It will be important that you identify your Preceptorship
sources of support very early on so that the feeling If you are a newly qualified nurse the NMC strongly
of isolation can be minimised. Good practice would recommends that all ‘new registrants’ have a period
be to be able to identify a support contact person of preceptorship on commencing employment
whilst working. Check with your local Clinical (2008).
Commissioning Group (CCG) to identify your local
nurse and find out about any local GPN forums.
Your local education and training board (LETB) may
have a GPN lead who is involved with advising on
training and development issues. In some areas the
The role of the ‘preceptor’ is to:
• Facilitate and support the transition of a new registrant.
• Facilitate the application of new knowledge and skills.
• Raise awareness of the standards and competencies that the new
registrant is required to achieve and support to achieve these.
• To providing constructive feedback on performance.
This is a crucial area of support, as the first year in practice is often a

stressful time. The learning that has occurred at university in order to
develop a level of knowledge and proficient skills in nursing produces
highly motivated and professional individuals. It is acknowledged that
the realistic nature of practice with all its resource issues and other
frustrations can lead to a demoralised nurse very quickly. A good
preceptor will be someone who will support the consolidation of
knowledge and skills, be a listening ear and be positive in their approach
to ensure that there is a low attrition rate. In some areas, courses that
are aimed at nurse new to General Practice may fulfill the requirements
for your preceptorship year. www.nhsemployers.org/campaigns/care-
makers/the-care-makers-hub/learning-and-development/preceptorship
Clinical Supervision
In some areas you may have regular clinical supervision sessions.
Clinical supervision in the workplace was introduced as a way of using
reflective practice and shared experiences as a part of continuing
professional development (CPD). It has the support of the NMC and
fits well in the clinical governance framework, whilst helping to ensure
better and improving nursing practice. GPNs may find that most of
their clinical supervision is done informally and possibly in a group, for
example at a GPN Forum.
The RCN have developed guidance on clinical supervision:

www.rcn.org.uk/__data/assets/pdf_file/0007/78523/001549.pdf
Traditionally clinical supervision may not have been accessible to
practice nurses due to the nature of their employment, often as the
only nurse in the practice. However the Care Quality Commission may
seek to establish that nurses have access to clinical supervision during
their inspection process. You should contact your Clinical Commission
Group lead nurse or equivalent for further advice.
Introduction of the Reflective Journal

Whilst completing this resource we recommend that you use reflection
as a tool to assist your learning. To reflect means to evaluate, consider
carefully, weigh up, ponder, contemplate or think purposefully about
something. The effect of doing this is to heighten your awareness of
what it is you are thinking about. You may be familiar with reflection in
your previous studies.
In March 2015 the NMC published their intentions for registered nurses
to undergo Revalidation. This is a new process by which you demonstrate
that you practice safely. All nurses and midwives are currently required to
renew their registration every three years. Revalidation will strengthen
the renewal process by introducing new requirements that focus on:
• up-to-date practice and professional development

• reflection on the professional standards of practice and behaviour
as set out in the NMC Code, and
• engagement in professional discussions with other registered
nurses or midwives
‘Reflection without action is wishful thinking.’
Here is the link for details on the new requirements Nursing and Midwifery Council (2015) The Code:
for Revalidation: www.nmc.org.uk/standards/ Professional standards of practice and behaviour for
revalidation/ nurses and midwives www.nmc.org.uk/globalassets/
sitedocuments/nmc-publications/revised-new-nmc-
Writing a Reflective Journal code.pdf
If you decide to hand write your journal then we
suggest that you record your thoughts and feelings Information Commissioners Office
about the learning gained from the resource in your • https://ico.org.uk/for-organisations/guide-to-data-
daily professional practice. Consider using a hard protection/data-protection-principles/
backed notebook that you can take with you on a
daily basis to record your experiences. • www.gmc-uk.org/guidance/ethical_guidance/
confidentiality.asp
We would also like you to consider using an e-journal
by clicking on the link below to develop a more Reflection (guided dialogue)
permanent professional journal as a way of recording In all professional roles it is important to reflect
your learning and development journey. upon a situation whether it is deemed as positive
h tt p s : / / e x ch a n g e . b c u c . a c . u k / e x ch w e b / b i n / or negative. Reflection is seen as a theory of critical
redir.asp?URL=https://sites.google.com/site/ thinking and is a process of reviewing an experience
appstepbystepuserguide2011/creating-your-portfolio- of practice in order to describe, analyse, evaluate
using-google-sites and so inform learning about practice (Boud et al
1985). Invariably it is human nature to reflect upon
In both instances it will be crucial that you share an occurrence when ‘something has gone wrong’
your journal with your mentor so that the experience (Taylor, 2006). Reflective practice advocates that we
does not become a ‘solitary’ exercise and you should also reflect upon good practice as a way of
gain from the reflective conversation and receive enhancing and reinforcing this practice and also as a
feedback form your colleagues and mentor. You will quality control mechanism.
be required to have completed five reflections that
you have discussed with another NMC registrant as There are many models of reflection that can be used.
part of Revalidation. This activity may count towards Models may be viewed as academic exercises that at
this requirement. times are poorly implemented and poorly understood
by practitioners (Quinn, 2008). The model that is used
Confidentiality is not as important as long as a process occurs. Johns
Confidentiality and data protection are important (1992) model of reflection is commonly applied, the
aspects of professional practice but now you must basics of which are:
consider how this will apply to you as a GPN. Think
about the differences such as working in a practice The process of reflection
local to where you live and what information might • Experience
be shared with colleagues, such as receptionists. • Perception
• Making Sense
The Data Protection Act has eight principles that • Principles
must be upheld. It is crucial that you familiarise • Application
yourself with these principles as well to ensure that
you maintain your accountability to your profession Reflection then becomes more than just a thoughtful
and your employer. practice; it becomes a process of turning thoughtful
practice into a potential learning situation (Johns,
Department of Health (2003) NHS Code of Practice: 1996).
Confidentiality. www.gov.uk/government/uploads/
system/uploads/attachment_data/file/200146/ The learning that occurs must be in some way utilised,
Confidentiality_-_NHS_Code_of_Practice.pdf and if it is viewed that practices or behaviours must
be changed then how these changes occur need to
www.gov.uk/government/uploads/system/uploads/ be considered: ’Reflection without action is wishful
attachment_data/file/200147/Confidentiality_-_NHS_ thinking” Freire (1972) cited in Ghaye (2011)
Code_of_Practice_Supplementary_Guidance_on_
Public_Interest_Disclosures.pdf

Here are some examples of reflective models that may assist you to
reflect.
In the ‘reflective cycle’ (Graham Gibbs, 1992), there are six steps to aid
reflective practice:
• Description: First you describe what happened in an event or

situation
• Feelings: Then you identify your responses to the experience, for

example, “What did I think and feel?”
• Evaluation: You can also identify what was good and bad about the
event or situation.
• Analysis: The ‘Feelings’ and ‘Evaluation’ steps help you to make

sense of the experience.
• Conclusions: With all this information you are now in a position to

ask, “What have I learned from the experience?”
• Action plan: Finally, you can plan for the future, modifying your
actions, on the basis of your reflections.
Here is a practice example of reflection using Gibbs:
• Description: First you describe what happened in an event or

situation: A patient attended for a travel vaccination late one
afternoon. She appeared nervous and said that she didn’t like
needles but was keen to have her ‘jabs’ as she was travelling on
her gap year and would be visiting many high risk areas. As soon
as I administered the vaccine she stated she felt unwell and then
collapsed.
• Feelings: Then you identify your responses to the experience, for

example “What did I think and feel?” I felt scared as I was alone
with the patient with no one to call. I was worried about whether
‘The Johari window model explores in depth parts of ourselves that
we may not as yet recognise.’
or not I would know what to do and how to treat
her. I felt an initial panic come over me and my
heart was pounding in my chest as I was unsure
whether she had fainted or was having an allergic
reaction to the vaccine.
• Evaluation: You can also identify what was good

and bad about the event or situation. ‘The good
aspect was that I made the right judgment about
her condition and felt in control medically. I acted
quickly, called for help and stayed with her until
she felt strong enough to get up from the floor
and I could assess her condition further. The
worrying aspect was that she almost fell off the
chair and could have sustained an injury from the
fall.’ Taken from Driscoll (2007) p44
• Analysis: The ‘Feelings’ and ‘Evaluation’ steps Johari Window (Luft and Ingham 1955)
help you to make sense of the experience. ‘I felt When making the transition in to a new working
happy that I had the ability to rely on my knowledge environment a model such as the Johari Window
and skills and made a rapid assessment of the might help to raise your self awareness, personal
patient’s vital signs. I also felt empowered as I development and group relationships. This can
felt confident that if it had been a more serious be useful as working within a General Practice is
event than a faint that I knew what action to take. very different from working in an NHS Trust. Your
The rapid response of my colleagues to my call relationship with your colleagues and employer may
was also reassuring.’ feel very different.
• Conclusions: With all this information you are Johari Window

now in a position to ask “What have I learned
from the experience?” I have learnt to trust my 1 2
clinical judgements more and to realise that I can Known self Hidden self
rely on my ability in this type of situation.
Things we know about Things we know about
• Action plan: Finally, you can plan for the future, ourselves and others ourselves that others
know about us do not know
modifying your actions, on the basis of your
reflections. ‘In the future I will always make 3 4
sure that patients are well prepared for their Blind self Unknown self
immunisations and will ensure they are lying
down if there is any risk of fainting.’ Things that others Things that neither we
know about us that we nor others know about
There are various models for reflection that you may do not know us
be aware of and use to reflect on practice. Some The Johari window model explores in depth parts
GPNs use Driscoll (2000) in particular for reflection of ourselves that we may not as yet recognise. The
in practice: challenge is to explore and understand a little bit
more about ourselves through a window framework:
1. Known self - these are things that you know

about yourself and that you may consciously
present to others
2. Hidden self - these are things that you know

about yourself but you choose to hide from
others

3. Blind self- these are things about you that others can see but are
unknown to you
4. Unknown self - these are feelings and abilities that you are not
aware of and which others have not seen
By considering the four domains it should help you to identify what

is known by you, what is known by others and what is yet to be
discovered. It can assist to get feedback on performance and increase
self- awareness of your own practice.
Here is the same practice example of reflection using Johari Window:

A patient attended for a travel vaccination late one afternoon. She
appeared nervous and said that she didn’t like needles but was keen
to have her ‘jabs’ as she was travelling on her gap year and would be
visiting many high risk areas. As soon as I administered the vaccine she
stated she felt unwell and then collapsed.
1. Known self - these are things that you know about yourself and
that you may consciously present to others. I felt happy that I had
the ability to rely on my knowledge of travel immunisations and the
management of anaphylaxis.
2. Hidden self - these are things that you know about yourself but
you choose to hide from others. I felt scared as I was alone with
the patient and felt totally responsible for the event. I was worried
about whether or not I would know what to do and how to treat her.
I felt an initial panic come over me and my heart was pounding in
my chest as assessed the patient’s condition.
3. Blind self - these are things about you that others can see but
are unknown to you. When reporting back to my senior nurse the
anxieties I had about this patient and how I acted, I was somewhat
surprised at the amount of faith she had in my ability to cope.
She stated that she could see how I had developed over previous
months and knew that this type of situation ‘would not faze me’.
4. Unknown self - these are feelings and abilities that you are not
aware of and which others have not seen. As I grow in experience I
feel that I am working towards a more senior role within the practice.
How to write reflectively

‘It is often difficult for professionals to say or write about what they
know and how they use their knowledge.’ Fook J and Gardner F (2007)
Practicing Critical Reflection McGraw Hill – Open University Press
Berkshire
Questions to use when writing reflectively:
• Where the event took place?
• Who was involved?
• What actually happened?
• How you were involved?
• What your feelings were at the time?
• What contribution did you make?
• What happened after the situation?
• What did you learn from this experience?
• New knowledge?
• New skills?
• Professional development?
• Personal development?
‘Think of every experience as a learning one.’
Tips on how to maximise learning time: General Practice Nurses’ Quotes

‘I had to learn to respect how other people choose to
• Think of every experience as a learning one- ‘talk live and not judge them.’
as you go’, externalise all your thoughts sharing
tacit knowledge. ‘It can be lonely at first but you are not on your own,
there is always a senior member of staff to help. This
• Capture all learning opportunities however minor. will be an exciting challenge in your professional life.’
• Try to promote professional conversations with ‘It will be completely different to anything you have
the mentor done before be prepared for a long and steep
learning curve - but it will be very worthwhile.’
• Develop ‘case studies’ that maybe used to
promote understanding. ‘It is totally different to working in a hospital and/
or nursing home environment so be prepared for a
• Try to have a short ‘review’ and evaluation session shock however it’s well worth the transition.’
at the end of each day.
‘If you like working independently, like to see a
Example of a reflective account variety of patients, from babies to the elderly,
‘Mary came to see me for a blood pressure check and want to build relationships in the community,
because her mother had recently had a heart attack. practice nursing is the job for you.’
Although she had recovered well and was now at
home the event had prompted Mary to think about ‘Use the practice nurse forum and network as
her own health. She was aware that cardiovascular much as you can with other practice nurses. They’re
disease could ‘run in the family’. an invaluable resource when you need to know
something quickly and don’t know where to find
I found Mary’s blood pressure to be raised and the answer and for support in an otherwise often
suggested that further review would be required isolated job.’
following some blood tests. I then began to talk Transition to
Chapter Summary
General
Practice
about some changes that Mary could consider such

Nursing
Contents
Nursing?
as a low salt, reduced fat diet but Mary became very This Chapter has highlighted some of the
General Practice
development
groups
upset and anxious about the possibility of her having differences of working in a hospital setting to
development
keeping up to date
a heart attack like her mother. primary care. It has started to get you to recognise
some of the personal challenges and changes in
Although she calmed down and agreed to further working in General Practice how to access support
review I felt I hadn’t handled the situation very well and the importance of working as part of a team.
because I hadn’t anticipated how affected Mary
would be about her raised blood pressure. I discussed Finally it has recommended a reflective journal as an
this with the lead nurse and she suggested we think aid to learning whist doing this online resource and
about how the situation had arisen and try to identify given you some ideas on how to reflect.
how a similar episode could be avoided in the future.
We identified that although Mary had presented Web Resources
for a blood pressure check she wasn’t prepared to • www.neighbourhood.statistics.gov.uk
learn that her blood pressure reading was high. I • www.census.gov.uk
suggested that if I had raised this as a possibility prior • www.direct.gov.uk
to measuring Mary’s blood pressure, I could have • www.marmotreview.org
explained the possible significance and reassured • www.nmc.org.uk/standards/revalidation/
Mary that this could be managed. She may then have
been more receptive to a conversation about making
healthy changes to her diet.
After this experience I plan to structure my

consultations differently and check my patient’s
understanding prior to undertaking any investigations.’

Transition to
General
Practice
Nursing
Contents
Nursing?
General Practice
development
groups

development
keeping up to date
Section B - Working in General Practice

• Explore some of the legislation that protects nurses working in
General Practice
• Consider your own and your patient’s personal safety when working
in general practice
Whilst working in general practice there is legislation that exists to

support and protect you in this environment and your employers, usually
the GPs, are bound to ensure that measures are in place to prevent or
minimise risk.
Some Legislation that protects working in general practice:

• Health & Safety at work Act (1974)
• Management of Health & Safety at Work Regulations (1999)
• Manual handling Operations Regulations (1992)
• Control of Substances Hazardous to Health Regulations (2002)
• Personal Protective Equipment at Work Regulations (1992)
Health & Safety at Work Act (1974) – section 7: the two points below
particularly relate to general practice nursing:
1. To take reasonable care of their own health and safety and any other
person who may be affected by their act or omissions
2. To co-operate with their employer so far as necessary to enable that
employer to meet their requirements with regards to any statutory
provisions
For specific guidance on safety in General Practice follow this link:

www.england.nhs.uk/ourwork/patientsafety/general-practice
Find out if your practice is ‘Signed up for Safety’ one of a set of initiatives
to help the NHS improve safety; you can also sign up as an individual.
The five ‘Sign up to Safety’ pledges

1. Putting safety first. Commit to reduce avoidable harm in the NHS
by half and make public our locally developed goals and plans
2. Continually learn. Make our organisation more resilient to risks,
by acting on the feedback from patients and staff and by constantly
measuring and monitoring how safe our services are
3. Being honest. Be transparent with people about our progress to
tackle patient safety issues and support staff to be candid with
patients and their families if something goes wrong
4. Collaborating. Take a lead role in supporting local collaborative
learning, so that improvements are made across all of the local
services that patients use
5. Being supportive. Help people understand why things go wrong
and how to put them right. Give staff the time and support to
improve and celebrate progress
Here is the link for further information:

www.england.nhs.uk/signuptosafety
‘In some cases there may be situations where the patient or relative
are unhappy with you or what your represent.’
Looking after yourself Remember, regardless of whether you are expected

It is acknowledged that working as a nurse comes to wear a uniform or not, you must use appropriate
with its own set of risks, while the nature of practice personal protective equipment such as disposable
nursing does reduce the risk of musculoskeletal gloves and disposable aprons. It is the duty of your
injury it is important to remain mindful of the employer to provide such equipment.
principles of safe moving and handling of patients.
For example assisting elderly or frail people prepare Violence , Aggression or Harassment
for examination or certain procedures that may Whilst in most situations patients and their relatives
require them to get up on a couch. are pleased to have the opportunity to receive care
from a nurse, in some cases there may be situations
• Do the couches have facility to adjust in height? where the patient or relative are unhappy with you or
• Think about how you might react if a patient what you represent. Remember as a practice nurse
collapsed and you were on your own in the room. you will be working alone but not in isolation. Often
• Do you have personal alarms or the means to call emergency call alarms are discretely placed so that
for help urgently? help can be summoned quickly if required. Please be
• What emergency equipment do you have and mindful of the following:
how is it maintained?
• What would you do in the event of a needlestick • DO NOT suffer in silence – communicate and
or body fluid splash? document any fears you may have to your
• What potentially harmful substances might you manager immediately. This may ensure the
be working with and what are you and your safety of colleagues or the wider healthcare team
employer’s responsibilities regarding safe storage so timely reporting is invaluable
and usage?
• The potential for an outburst is a very real one
Physical risks
• Musculoskeletal – a quarter of all nurses have at • Try to avoid vulnerable or volatile situations at all
some time taken time off as a result of a back times
injury
• Stress- work related stress accounts for over a • Be aware that relatives can be unpredictable at
third of all new incidents of ill health times
• Slips and trips- two thirds of all major injuries
Health and Safety Executive (2007) • Have a clear understanding of your practice policy
on Violence , Aggression or Harassment
What to wear?
In some practices it will be employer policy to wear a • Employers must take steps to keep staff safe at
uniform and this is provided. In other areas it may be all times
policy not to wear a recognised uniform. It should be
noted that there are advantages and disadvantages • Aggressive behaviour from patients toward staff
of wearing a uniform in general practice. is unacceptable and may sometimes lead to the
patient’s removal from the General Practice list.
When wearing a uniform you are easily recognisable
and some patients relate well to this. It allows you In some instances you may find it safer to see
to ‘set the scene’ early on and boundaries are clearly patients with another member of staff or chaperone.
identified. It also allows patients to understand the The assessment resulting in this decision would
different roles within the practice. normally have been discussed within the practice
team and it will be down to team members to adhere
Sometimes a uniform can be viewed by the patient to this plan of care.
as a ‘barrier’ and they feel more comfortable with a
nurse if they are wearing their own clothes. As part of your learning for this Chapter it is
recommended that you read your practice policy on
Whether wearing a uniform or not you will be acting Violence and Aggression or Harrassment.
in the role of a nurse and it will be essential that you
remain professional in both your appearance and Action: read your practice policy for
behaviour regardless of uniform. chaperoning.

Medicines Management
The way in which medications are administered and managed
is different in the General Practice setting and again it is about you
becoming familiar with the differences. The same rules apply in terms
of the safe administration and monitoring of medicines, however within
the General Practice environment more emphasis is placed upon other
factors such as risk, storage and disposal of drugs. Here are some
helpful tips:
• Make sure that you have seen a copy of the NMC ( 2010) Standards
for Medicines Management (NMC London)
• Know your practice policy on the storage administration and

management of medicines
• Some practices stock controlled drugs. Ensure you know the

procedure for the management of controlled drugs, including
issuing prescriptions for CDs.
• Some general practice nurses and community nurses are

independent prescribers (V300 NMP, prescribe from the whole
formulary)
• Others may prescribe working in partnership with GPs under

‘Patient Group Directives’ e.g. immunisations
• Some medications are administered under ‘Patient specific

directives; eg B12 injections.
Ensure you are clear about the legal definitions of these different ways
of administering medicines.
Here is the link to NICE guidance on medicines management and the

use of PGDs: www.nice.org.uk/guidance/mpg2
The British National Formulary (BNF) is compiled with the advice of

clinical experts and is an essential reference providing up-to-date
guidance on prescribing, dispensing and administering medicines. The
online version is usually available to GPNs in the practice.
The Green Book has the latest information on vaccines and vaccination
procedures, for vaccine preventable infectious diseases in the UK and
is available online: www.gov.uk/government/collections/immunisation-
against-infectious-disease-the-green-book
• Get to know your local pharmacist who will be invaluable for

information and advice
• Ask if your mentor if you are unclear.
Some practices dispense medicines for their patients, usually if there

is no local pharmacy nearby. You will need to familiarise yourself with
the arrangements for your practice as there may be special rules around
dispensing.
Action: read your practice policy on Medicines Management.
Infection Control
As part of your learning for this Chapter it is recommended that you
‘An increase in reporting patient safety incidents is a sign that an
open and fair culture exists, where staff learn from things that go
read your Practice policy on Infection Control and any Further resources can be found here:
local CCG policies. www.england.nhs.uk/wp-content/uploads/2015/02/
gp-nrls-rep-guide.pdf
The Care Quality Commission is the independent
regulator of health and adult social care in England. It Safe Working Activity
is responsible for ensuring that all health and social
Think about your own day to day practice:
care services provide people with safe, effective,
• When have you felt at risk?
compassionate, high-quality care. They monitor,
• Have you ever performed a risk assessment?
inspect and regulate services to make sure they
A risk assessment is simply a careful examination
meet fundamental standards of quality and safety
of what, in your work, could cause harm to people,
and publish their findings including performance
so that you can weigh up whether you have taken
ratings to help people choose care.
enough precautions or should do more to prevent
harm. Workers and others have a right to be
There are 16 standards that services are required to
protected from harm caused by a failure to take
meet: the specific standards that relate to providing
reasonable control measures.
a safe environment are:
• Whose responsibility is it to risk assess?
The management of risk is considered one of the
Outcome 8: Cleanliness and infection control
fundamental duties of every member of staff and it
People should be cared for in a clean environment
will be part of your role to familarise yourself with
and protected from the risk of infection. Be mindful
the risk factor
that infection control procedures may be different in
• Do you have a policy of safe practice e.g.
general practice to hospital e.g. the management of
when finishing at the end of the shift- how do
a patient with MRSA.
colleagues know you are safe?
Outcome 10: Safety and suitability of premises
Case scenario
People should be cared for in safe and accessible
1 – Safe working
surroundings that support their health and welfare as
An elderly male patient attends the practice regularly
is the case in hospital.
for dressings to his leg ulcers. On occasions he
seemed to be over friendly, asking the female
Ensure that you are up to date with mandatory
nurse some personal questions. On one occasion
training regarding fire safety.
he attempted to kiss the nurse before leaving the
treatment room. There was no reason to believe he
Action: consider what the policy is in your
was suffering from a mental health issue or lacked the
practice on managing needle stick injury.
mental capacity to be responsible for his behaviour
.The first time it happened she tried to avoid the
• You must consult local infection control
subject but when he increased the intensity on the
guidelines and seek local microbiology advice with
second visit she brought it to the attention of her
respect to local management policies for MRSA.
Practice Manager/GP.
Duty to report incidents Reflection:

It is your professional duty to act to preserve • What would you do in a situation like
safety (NMC 2015) and to ‘act without delay if you this?
believe that there is a risk to patient safety or public • Does your practice have a policy that would relate
protection’ (p12). to such an incident?
• What legislation if any could protect you as a
The National Reporting and Learning Systems (NRLS) worker from this situation?
state that ‘an increase in reporting of patient safety
incidents is a sign that an open and fair culture exists, Possible action:
where staff learn from things that go wrong.’ • Challenge the man if you feel able and inform him
that his behaviour is not appropriate
In February 2015 a general practice e-form was • Inform the man of the possible implications of his
launched; the eform can be copied onto your desktop behaviour
or accessed here: https://report.nrls.nhs.uk/GP_ • Most definitely inform your mentor and manager
eForm and document both incidents

• Ensure that you feel supported before you see this patient again
• Adhere to your Practice Policy on this type of behaviour
• Most practices will have a policy on the use of chaperones; ensure
you are familiar with this policy. How might this be relevant to this
scenario?
• Consider whether this is sexual harassment?
Reflection Trigger point – What would you do if?

These reflection triggers are for you to get together with your
mentor and if appropriate other team members to debate possible
solutions. They could be used as a basis for a discussion or even a
teaching session. We are aware that the solutions to these triggers may
vary from Practice to Practice according to local policy and procedure.
We are also aware that there may be no ‘right or wrong’ answers to
how certain situations might be tackled and therefore it will be for you
as a qualified nurse to apply your thinking within the parameters of your
own professional practice.

‘... To understand that the risks in a community setting are different and
you need to be able to manage those risks differently.’
‘If you feel vulnerable and are not sure of what you are doing please
ask!’
Action
• Read your practice policy on infection control
• Read your practice policy on Incident Reporting
• Familiarise yourself with the Mental Capacity Act and ensure you
understand its principles.
Transition to
Chapter Summary
General
Practice
Nursing
Contents
Nursing?
This Chapter has introduced some of the key issues of safe

General Practice
development
groups
working in the primary care setting. It has explored the key

development
keeping up to date
legislation that protects general practice nurses.
In particular it has highlighted some of the personal safety issues that

need to be taken into consideration when working in the primary care
setting.
Web resources
• www.cqc.org.uk Care Quality Commission
• www.suzylamplugh.org The Suzy Lamplugh Trust
• www.rcn.org.uk RCN
• www.unitetheunion.org Unison & CPHVA/Unite
Legislation Links
Health & Safety at work Act (1974) www.legislation.gov.uk/ukpga/1974/37
Management of Health & Safety at Work Regulations.(1999)

www.legislation.gov.uk/uksi/1999/3242/contents/made
Manual handling Operations Regulations (1992)

www.legislation.gov.uk/uksi/1992/2793/contents/made
‘The risks in a community setting are different and you will need to
be able to manage those risks differently.’
Control of Substances Hazardous to Health
Regulations (2002)
www.legislation.gov.uk/uksi/2002/2677/contents/
made
Personal Protective Equipment at Work Regulations

(1992)
www.legislation.gov.uk/uksi/1992/2966/contents/
made
Occupiers’ Liability Act (1957)

www.legislation.gov.uk/ukpga/Eliz2/5-6/31/contents
Health and safety Executive

www.hse.gov.uk
Nurse prescriber www.nurseprescriber.co.uk
Standards for proficiency in nurse prescribing

www.nmc.org.uk/globalassets/sitedocuments/
standards/
RCN fact sheet Nurse Prescribing in the UK

www.rcn.org.uk/__data/assets/pdf_
file/0008/443627/Nurse_Prescribing_in_the_UK_-_
RCN_Factsheet.pdf
Medicines and Healthcare Products Regulatory

Agency
www.mhra.gov.uk/Safetyinformation/
Healthcareproviders/Generalpractice/

Transition to
General
Practice
Nursing
Contents
Nursing?
General Practice
development
groups

development
keeping up to date
Chapter 4 - Patient Focus

• Explain the Quality Outcome Framework, what Local Enhanced
Services are and the role of the GPN in achieving targets
• Define Long Term Conditions and their impact on the patient
• Consider the role of the general practice nurse when caring for
patients with Long Term Conditions and Palliative care
• Develop an understanding of the resources and networks available
for this group of patients
The Quality Outcomes Framework

General Practitioners are contracted by the NHS to provide primary care
services to a local population. This is known as the General Medical
Services (GMS) contract. The GMS contract was introduced in 2003
and covers three main areas:
1. The global sum – covering the costs of running a general practice,

including some essential GP services
2. The quality and outcomes framework (QOF) – covering the two
areas of clinical and public health. Practices can choose to provide
these services
3. Enhanced services (ES) – covering additional services that practices
can choose to provide. ES can be commissioned nationally or locally
to meet the population’s healthcare needs.
The QOF consists of ‘clinical domains’ that relate to long term or

enduring medical conditions that patients may present with such as
diabetes. Practices are required to hold registers of their patients with
these specified conditions and to meet specific targets relating to their
management in order to achieve the additional funding. There are also
public health domains such as the primary prevention of cardiovascular
disease.
Each domain is worth a fixed number of points and practices score

points according to the level of achievement within each domain. The
higher the number of points achieved, the higher the financial reward
to the practice. The aim of QOF is to improve standards of care, provide
information and to enable practices to benchmark themselves against
local and national achievements (The Health and Social Care Information
Centre, 2012). The GMS contract also offered practices access to
additional funds for local enhanced services. These are also services
that may be offered in addition to the general services provided, for
example:
• Alcohol-related risk reduction scheme

• Learning disabilities health check scheme
• Facilitating timely diagnosis and support for people with
dementia
• Patient participation
• Extended hours access.
In April 2009 the National Institute for Health and Clinical Excellence
(NICE) became responsible for managing the QOF clinical and health
improvement indicators. As part of this process, NICE, in consultation
‘A fundamental role of the GPN is the care of those registered
patients that are living with a Long Term Condition (LTC).’
with individuals and stakeholders, prioritises areas Health policy in the UK has been shaped to an extent
for new indicator development and then develops by American policy on long term conditions and no
the indicators to be included. The National Institute explanation of this policy would be complete without
of Health and Social Care Excellence (NICE) provides reference to the Kaiser Permenante triangle (DH
information that is used to inform the annual 2005a).
contract negotiations between NHS Employers and
the British Medical Association. Therefore the QOF This model acknowledges that people affected
requirements are regularly reviewed in order to or potentially affected by LTC’s have differing and
reflect best evidence in disease management. complex needs.
www.nhsemployers.org/~/media/Employers/ Level one refers to 70-80% of the population that self

Documents/Primary%20care%20contracts/ manage their own condition and may require advice
QOF/2014-15/14-15%20General%20Medical%20 on health promotion.
Services%20contract%20-%20Quality%20and%20
Outcomes%20Framework.pdf Level two are those with a disease specific unstable
long term condition this is the level at which GPNs
www.nhsemployers.org/your-workforce/primary- are mostly likely to be involved.
care-contacts/general-medical-services/quality-and-
outcomes-framework/changes-to-qof-201415 Level three are those with highly complex multiple
conditions that require intense case management and
The management of long term conditions has been these patients are usually cared for by a community
a key feature of QOF and much of the work of the matron or equivalent case management worker.
GPN is crucial in enabling practices to achieve their
QOF targets. The ACEVO (Association of Chief Executives of
Voluntary Organisations) Taskforce on Prevention in
Long Term Conditions Health was established in 2012 to examine ways to
A fundamental role of the General Practice Nurse is encourage a shift in focus and investment towards
the care of those registered patients that are living preventative health and care provision. They produced
with a Long Term Condition (LTC). LTCs have been at a report that called for a fundamental change in
the top of the government’s health agenda for many behaviour and culture throughout the health and social
years. It is estimated that fifteen and a half million care system: a ‘Prevention Revolution’. It sets out a
people in the UK have a long term condition (DH number of key recommendations aimed at creating
2008b). The cost of this is significant, with people the conditions for change to occur. Throughout the
with LTC’s accounting for a large proportion of the report the emphasis is on the role that the voluntary
and community sector must play in promoting
innovation and transformation throughout health and
social care. The report can be accessed at: www.
acevo.org.uk/prevention-revolution
Action: consider what voluntary and social

care services there are in your area and how
you might work together to improve health
outcomes for your practice population.
Living with a Long Term Condition

For some people, being diagnosed with an LTC can
be devastating and there is a feeling that their life
will change for good. Patients may have already lived
with the uncertainty of symptoms including pain,
discomfort, disability and the anxiety of not knowing
what is wrong with them. Features of a LTC include
symptoms that have become intrusive, have gone on
NHS budget (Darzi 2007). for longer than six months, multiple pathology and if
the person requires medical intervention.

In order to assist these patients as a General Practice Nurse you will
be involved in care planning in order to address the range of needs that
these patients present with. You will be required to take into account
their personal, psychological, health, family, social, economic, ethnic
and cultural circumstances. It will be vital for you to understand the
need for individualised care planning in order to provide quality care
to all your patients. Assessment is a core skill of the General Practice
Nurse and you will have the opportunity to learn and develop some
of these skills whilst working alongside those GPNs with specialist
skills and knowledge in the management of LTCs. It will be your role
to provide a person-centred approach to care and assist in some of the
decisions made to optimise patient care.
Also important is the notion of self-care, where patients take

responsibility for themselves to stay well and maintain their wellbeing
by being informed about their LTC. As a General Practice Nurse your
role here will be about health education and promotion.
Increasingly GPNs are developing and utilising additional skills like

motivational interviewing to assist patients with lifestyle changes, such
as healthy eating.
You will also be involved in sign posting patients to the most appropriate
source of information to assist them in making the right choices for them.
This might include helping patients to develop their own personalised
care plans. www.gov.uk/government/publications/improving-care-for-
people-with-long-term-conditions-at-a-glance-information-sheets-for-
healthcare-professionals
Activity: Think about some of the patients who may have

registered with your practice. In what ways might you promote
self- care?
• Think about how you could promote your patient’s knowledge of
health related issues
• How could you direct them to more information and what would
be the best source of information for them taking into account the
person
• Can you think of where you could access resources to help you to
inform them better?
Here is a list of some of the types of LTCs

• Cardiovascular/ circulatory conditions: venous/arterial leg ulcers,
coronary artery disease, hypertension, congestive heart failure,
valve or arterial occlusive disease.
• Endocrine conditions: diabetes mellitus, hyperthyroidism,
hypothyroidism.
• Respiratory conditions: asthma, cystic fibrosis, occupational
respiratory diseases, chronic obstructive pulmonary disease.
• Neurological conditions: Parkinson’s, Alzheimer’s, multiple sclerosis,
motor neurone disease.
• Immune and haematological conditions: HIV, hepatitis, haemophilia,
sickle cell disease, thalassaemia, rheumatoid arthritis, systemic
lupus erythomatosus, iron deficiency anaemia.
• Cancers: lung, colorectal, head and neck, breast, cervical, bladder
leukaemia, etc.
• Gastrointestinal conditions: irritable bowel syndrome, inflammatory
bowel disease, cirrhosis, chronic pancreatitis, hiatus hernia,
constipation, faecal incontinence.
‘Being assertive does not always mean you get what you want, but it
can help you achieve a compromise.’
• Renal and urological conditions: chronic renal Here are a few articles that you may find useful when
failure, neurogenic bladder, urinary incontinence. considering how to boost your confidence.
• Gynaecological conditions: endometriosis,
fibroids, infertility. • http://transitionsinnursing.com/9-ways-to-boost-
• Musculoskeletal conditions: osteoporosis, your-confidence-as-a-nurse/
osteoarthritis, chronic back pain, scoliosis. • www.nursingtimes.net/nursing-practice/clinical-
• Dementia zones/management/boost-your-confidence-to-
• Spinal conditions reach-the-stars/5044830.article
• www.nursingtimes.net/nursing-practice/career-
Voluntary Organisations development/boost-your-confidence-and-get-
• Mind www.mind.org.uk noticed/5039336.article
• Age UK www.ageuk.org
• MS Society www.mssociety.org.uk End of Life Care
• Diabetes UK www.diabetes.org.uk As a General Practice Nurse you may get involved
• Asthma UK www.asthma.org.uk with the care of patients at the end of their life. The
• British Heart Foundation www.bhf.org.uk term ‘End of Life Care’ (EoLC) is relatively new and
• Alzheimer’s Society www.alzheimers.org.uk includes wider aspects of care of the dying e.g.
supportive, palliative and terminal care that could
Practicalities of supporting people with go on for the last years, months or weeks of life.
LTCs Macmillan nurses and palliative care nurses will be
There are some fundamental clinical skills that are included in the wider multi-disciplinary primary care
required when caring for people with LTCs and these team and will work closely with GPs and GPNs in
will be addressed in Chapter Five. It is also important sharing expert knowledge and providing support
to assess your own current knowledge and abilities when caring for those patients at the end of life.
regarding certain conditions either according to Caring for someone suffering from dementia at
their prevalence within your practice or if you have End Of Life can prove extremely difficult without
a particular interest in an illness or condition. Some appropriate training; it is a growing area of need in
local organisations may be a valuable source for this the community also caring for patients at end of life
type of information as they will be current and up who have learning disabilities is a growing concern.
to date on treatments and initiatives relating to the
national guidelines and strategies. Dementia Care
There are around 750,000 people living with dementia
Advocacy in the UK. It affects around two thirds of women
As a General Practice Nurse you will have to start mainly due to the fact that women live longer than
to establish a personal authority and assertiveness men.Having dementia does not automatically mean
in order to influence other health and social care you have to go into a care home or hospital. Two–
professionals, colleagues and patients to promote thirds of people with dementia live in the community.
care. Being assertive means respecting yourself and With the right support people diagnosed with
other people, seeing people as equal to you, not better dementia can remain at home if they wish to (if it is
or less important than you. The goal of this assertive practical and safe to do so).
behaviour in this context is to stand up for patient’s
rights and act as an advocate (be careful doing this, The government launched a campaign called
it takes time to gain respect and understand all the Dementia Challenge in March 2012. The aim was
implications of an LTC on a patient and their family. to drive improvements in health and care, creating
dementia friendly communities and better research
Being assertive does not always mean you get what the condition. It has just published a report a year on:
you want, but it can help you achieve a compromise. www.gov.uk/government/news/report-marks-
You will need to develop a deeper degree of self progress-in-first-year-of-dementia-challenge
- awareness, self-belief in your ability to convey
information with confidence and conviction. The strategy aims to improve the diagnosis rates
of dementia by making sure that doctors give 65 to
‘You need to learn the art of acting, of appearing 74 year olds information about memory services as
confident even if inside you are scared…..most part of the NHS health check programme, and refer
important is learning to be confident.’ Stewart (1989) them for assessment if they need it (from April 2013).

In addition a new toolkit to help GPs provide better support is to be
launched. www.rcgp.org.uk/clinical-and-research/clinical-resources/
dementia.aspx
As a General Practice Nurse you will undoubtedly come into contact

with patients and carers with dementia. The symptoms of dementia
occur in three domains:
1. Difficulties with activities of daily living- e.g. personal care

2. Behavioural and psychiatric problems e.g. personality and emotional
changes
3. Cognitive dysfunction that may affect speech, language, memory
and orientation.
Also access www.cks.nhs.uk/home- This is a good source of information

on a range of common condition managed in primary care. There are
many groups and charities set up to support people living with this
condition:
www.nhs.uk/Conditions/dementia-guide/Pages/dementia-carers.aspx
Watch David Cameron talk about Dementia Friends:

www.youtube.com/watch?v=mXryu-1-9xw&feature=youtu.be
www.dementiacare.org.uk
Support
Support mechanisms have already been discussed within this resource
and this is just another quick reminder of the importance of accessing
support if needed. Caring for patients with LTCs and at the End of Life is
mentally and physically draining at times and you need to be aware that
the effects can take hold of you when you least expect it. Remember
that your colleagues in the team are experienced in this kind of caring
and can be a ‘listening ear’ when it all gets too much for you. Handover
is a good forum to air your thoughts and feelings about a patient, also
clinical supervision (if you can access it) is another forum to share with
colleagues any challenges you are facing when providing care.

‘I enjoy looking after patients long term, looking after patients of all
ages.’
‘I enjoy managing chronic diseases; seeing patients regularly; each day

being different. Building up a relationship with regular patients.’
‘Chronic disease management; variety of the day seeing a wide range

of patients.’
Chapter Summary
Transition to
General
Practice
Nursing
Contents
This Chapter has raised some awareness of the vast topic of

Nursing?
General Practice
development
LTC’s and End of Life. It has introduced the concept of self-

groups

development
keeping up to date
care and the importance for people to feel supported to make

decisions despite their condition. As a general practice nurse the
challenges posed by caring for this growing group of people is never
ending and will require a real understanding of partnership working
when addressing the needs of those experiencing the effects of
an LTC. You will almost certainly be required to specialise in certain
aspects of care or in specific conditions and many opportunities for
further education and training will be available.
‘As a GPN the challenges posed by caring for this growing group of
people is never-ending.’
Web Resources
• w w w. g o l d s t a n d a r d s f r a m e w o r k . n h s . u k /
TheGSFToolkit
• www.depression-primarycare.co.uk
• www.nice.org.uk The National Institute for Health

and Care Excellence
• www.helpthehospices.org.uk Help the Hospices

Transition to
General
Practice
Nursing
Contents
Nursing?
General Practice
development
groups

development
keeping up to date
Chapter 5 - Mid-point reflection and progress check on
identified skills development
The aim of this chapter is to:

• To reflect upon the experience of the on-line resource so far
• Catch up with reflective diary
• Re-visit additional skills that you may need to achieve in order to
work in general practice
Working in General Practice requires practitioners at all levels to be

resourceful, flexible and adaptable to the various situations you may be
confronted with. However, whilst adaptability is a key skill required,
it does not mean cutting back on quality of care. Decisions have to
be made around resources and skill sets of individual teams. In many
instances there will be limited resources so it is important to have
the ability to prioritise care. General Practice works best when the
individual skills of each practitioner is acknowledged and recognised,
regardless of what their grading is. Working in General Practice can
be unpredictable and challenging and skills are required to adapt to
the variety of presentations you will encounter during the course of a
typical surgery. The ability to work with the various emotional situations
is imperative.
Quality care is based on the effective clinical decision-making skills of

GPNs. Thompson et al (2004) recognised that clinical decisions made
in General Practice have very different parameters than when making
a clinical decision in a busy ward. Unlike on the wards where there
are a number of staff to share decision-making, you may be working
autonomously on a one-to-one basis with your patient. Therefore the
GPN must be prepared for the unexpected at all times, but also be able
to look at the needs of carers/families in the overall planning of care.
Decisions may have to be made promptly without discussion with

other staff. On occasions there may be a number of decisions to make
in order to give the patient the best quality care. It is the duty of all
health professionals to be accountable in demonstrating sound clinical
judgement and decision making (Standing, 2010). When contemplating
making a clinical decision Facione (2007:23) suggests the six steps to
effective thinking and problem solving:
Ideals 5 Whats and a Why

Identify the problem What’s the real problem we are
facing here?
Define the context What are the facts and circum-
stances that frame this?
Enumerate choices What are our most plausible 3 or
4 options?
Analyse options What is our best course of ac-
tion, all things considered?
List reasons explicitly Let’s be clear: Why are we mak-
ing this particular choice?
Self-correct Okay, let’s look at it again, what
did we miss?
‘The overall sucess of any nurse/patient relationship is built on
communication.’
Whilst the list below focuses on clinical skills it must • Would you continue with applying the same
not be forgotten that the overall success of any dressing to the wound ?
nurse/patient relationship is built on communication. • Would you consider applying a new (different)
Therefore communication channels must be open to dressing to the wound ?
generate discussions with your patients so, wherever • Would you ask the GP or a nursing colleague?
possible, they are part of the clinical decision making • If you are a nurse prescriber what would you
process in their plan of care. prescribe for Mrs Wray?
• What is the rationale for your decision?
Skills
• Medicines management in the primary care Possible actions :
setting-working with PGD • You could apply the same dressing to the wound
• Travel vaccinations and child health immunisations and review with a colleague on another day.
• Sexual and reproductive health • You could apply a different dressing to the wound
• Cervical screening if you are a prescriber and can prescribe from the
• Wound and leg ulcer assessment and NPF
management including: use of Doppler, wound • You could contact the GP and ask him/her to visit
products, compression bandaging to assess the wound. Or you could contact an
• Ear irrigation Independent Nurse Prescriber or Tissue Viability
• Venepuncture Nurse to assess the wound
• Palliative Care • Would any of these actions compromise the care
• Care of patients with LTCs particularly asthma, of your patient?
diabetes, hypertension, Chronic Obstructive
Pulmonary Disease (COPD), Atrial fibrillation (AF), Case study 2
Cardio Vascular Disease (CVD) Ellie aged 18 months has been brought to your clinic
by her mother for her MMR vaccination. During your
Here are just a couple of statements relating to skills assessment you ask about any reactions to previous
taken from the questionnaire sent out to general immunisations and her mother tells you that Ellie had
practice nurses: a really bad swelling around the injection site and
was quite unwell.
‘I’m anxious about giving injectable medications that
I am unfamiliar with and feeling the need to be able • Would you give the immunisation ?
to double check what I am giving. Particularly anxious • How would you assess what action to take?
about baby immunisations and travel vaccinations.’ • Where could you get further advice from?
‘As a relatively experienced nurse of over 25 years Possible actions:

experience (Wards, A&E, Community and latterly • You could postpone the immunisation
Walk In Centre) I still REALLY struggled with General • You could check the patients records to see if
Practice. The skills needed are unique to GP and an accurate assessment of the reaction was
cannot be learnt in any other fields. Even if you could recorded
do smears with your eyes closed you would struggle • You could ask the GP or lead nurse for advice
with leg ulcers.’ • You could check the Green Book online for
further information www.gov.uk/government/
Activity: How would you deal with the two collections/immunisation-against-infectious-
situations below? disease-the-green-book
• Remember you are weighing up the risks to
Case study 1 the patient against the benefit of immunisation.
Mrs Wray is a regular patient that attends the surgery You must always ensure that you have a clearly
three times a week for dressings to her venous leg thought through rationale for the decisions you
ulcer. Mrs Wray lives alone with her cat; she has take.
not been very mobile since she developed her leg
ulcer 4 months ago. On her latest visit you notice Additional Skills Quotes
that the leg is very inflamed around the outside of Look at the additional quotes below and think of
the ulcer. Following a thorough general assessment what you would do if you are asked to carry out
what clinical decisions would you make ? ear syringing, venepuncture or give a contraceptive

injection. Do you have the right skills to carry out the treatment? If not,
what will you do to gain the required skills?
‘I feel there is a lack of training in this area - ears are sometimes

syringed at patient request, historical expectation before ascertaining
actual need for this procedure.’
‘Everything that was listed were matters of concern but even though
I was the only practice nurse I was able to liase with an experienced
nurse from another practice. This to me was extremely helpful and I
would have not been able to pursue my new role without this amount
of help.’
‘It is important to note that you will not have all the skills and you may
not have all of the answers all of the time. In recognising this it is also
important to address this and take action where it is needed.’
Transition to
Chapter Summary
General
Practice
Nursing
Contents
Nursing?
The overall aim of this chapter is to revisit the skills that the
General Practice
development
groups
GPN needs to develop. Whilst it is acknowledged that the skills

development
keeping up to date
required for working in general practice are multifaceted, it is hoped

that this chapter will recognise that not everyone will have all the
required skills all of the time. Therefore it is essential that the General
Practice Team works together to recognise its combined expertise and
on occasions look beyond their team and reach out and utilise those
people who have the right skills for the task in hand. This supports the
QNI’s Right Skills, Right Nurse campaign.
Further Reading
• Facione, P.A. (2007) Critical Thinking: What it is and why it counts.,
California Academic Press, California
• Standing, M. (2010) Perceptions of clinical decision-making a matrix

model, McGraw Hill,London
• Thompson, C. Cullum, N. McCaughan, D. Sheldon, T. Raynor, P.

(2004) Nurses, information use, and clinical decision making –
the real world potential for evidence-based decisions in nursing,
Evidence Based Nursing, 7, p68-72
• www.skillsforhealth.org.uk Skills for Health

Transition to
General
Practice
Nursing
Contents
Nursing?
General Practice
development
groups

development
keeping up to date
Chapter 6 - Team working and working with other
professionals

• Explore the benefits of working as a team member
• Recognise the importance of working with other professionals in
primary care to ensure that the right staff, with the right skills are
in the right place
• Understand the importance of various forms of communication in
primary care for effective patient care.
The QNI has been campaigning for three years for the right balance
of skills in community healthcare teams. If more care is going to be
delivered in primary care, including in nursing homes, it is vital that
there is more investment in well trained staff, including nurses, who
have the time and the expertise to give high quality, compassionate
and person-centered care to the most vulnerable members of society
(QNI 2012).
Collaborative ways of working

‘Collaboration is the act of coming together and working with another,
or others, to create something that goes beyond the ability of any one
person to produce’ (Teatro, 2009)
Genuine collaborative working is the coming together with a common

purpose with clear goals. Multi-disciplinary teams work with the sole
purpose of delivering effective care to the patients and clients on their
caseload. This is not just a matter of being told to carry out a certain
task it involves discussion and debate about what is best for the patient/
client. All members of the team should be involved in the discussion,
as every team member will have a valuable contribution to make. The
philosophy of collaborative working should be to ensure that the patient
is at the centre of all discussions and their needs should far outweigh
those of the professional involved in their care.
Drew (2011) states that it is very important that time is spent on reporting
accurately within primary care as a means of safeguarding patients. It is
essential that there is a process for disseminating information among
the multi disciplinary team.
Reflection
• How does it feel to be a member of your team? Do you
feel valued?
• Apart from your team who else could you potentially collaborate
with to benefit the care you give to your patient?
Exercise:
• Can you look at the team that you are working with and
identify who you collaborate with on a regular basis?
• What impact does this collaboration have on you as part of the
team?
• If you had not collaborated with others would the quality of care
have been as good for your patient?
Spend a few moments to think of the various ways that you collaborate
‘If it is not written down there is a sense that somehow ‘it didn’t
happen’.’
with others in the workplace? other records eg. District Nurse records, dietician
• Verbal communication notes and social care notes to name a few. Also
• Telephone familiarise yourself with record keeping in areas such
• Written: emails/letters as residential homes/day units or other areas where
you may be visiting patients in the community.
These are just a few methods of collaborating, there
are also a number of technical ways of communicating. The NMC Code (2015) includes direction on record
keeping, you must keep clear and accurate records
Can you think of times when you would use media relevant to your practice:
such as Facebook or Twitter with your patients –
would you use this method? • Clear and accurate
• Factual, consistent, and relevant
• If you would use this method what are the • Comprehensive and useful
benefits? • Contemporaneous (made at the time).
• If you would not use this method of collaborating www.nmc.org.uk/standards/code/read-the-code-
– why not? online/#fourth
Here is the link to the NMC Social Networking In General Practice you will be using specific
Guidance (2015) www.nmc.org.uk/standards/ computer systems such as System one VISION, and
guidance/social-networking-guidance EMIS for record keeping, medicines management
and for clinical information. You should receive
Possible Actions appropriate training to enable you to use these
• You could set up a Facebook page for patients systems effectively.
with a similar condition eg. leg ulcers. This would
give the patients the opportunity to share stories The other element of accurate record keeping relates
with other people in a similar position and it may closely to investigations and serious untoward
make the patient feel less isolated. If a patient incidents (SUI) (DH, 2006b). The principle definition
was familiar with Twitter then they could follow of an SUI is:
someone with a similar condition. They could ‘.. something out of the ordinary or unexpected, with
follow the NHS choices on Twitter which would the potential to cause serious harm, that is likely
keep them updated. to attract public and media interest that occurs on
NHS premises or in the provision of an NHS or a
• Reasons for not using these methods are obvious commissioned service. SUIs are not exclusively
ones, such as your patients not having access to clinical issues, for example, an electrical failure may
smart phones or computers. Other reasons might have consequences that make it an SUI.’ (NHS, 2009).
be your patient’s inability to use technology. Your
patient may interpret information incorrectly and Significant Event Analysis is an increasingly routine
therefore cause them more anxiety. part of General Practice. It is a technique to reflect on
and learn from individual cases to improve quality of
• Can you think of more reasons why you would not care overall.
use social media technology with your patients?
Significant event audits can form part of your individual
Record Keeping and practice based learning and quality improvement
Record keeping is a way of collaborating with all and the process mirrors that of your own reflections
those involved in the care of your patient. Accurate on practice as a General Practice Nurse.
record keeping and documentation is important in
professional practice. Once something is written Whether clinical, administrative or organisational, the
down, it is a permanent account of what has happened significant event analysis process should enable the
and also what has been said. Remember, if it is not practice to answer the following questions:
written down there is a sense that somehow ‘it didn’t
happen’. Without a written record of events there is • What happened and why?
no evidence to support a decision made or an audit • How could things have been different
trail from which to follow a sequence of events. It is • What can we learn from what happened?
therefore crucial that accurate and consistent records • What needs to change?
are kept at all times. Ensure you are familiar with
A further worthwhile question is:
• What was the impact on those involved (patient, carer, family, GP,
practice)?
This reinforces the importance of accurate record keeping by all

health professionals. Many patients also have patient held records and
therefore it is essential that this information is kept up to date so that it
can be shared with other members of the multi disciplinary team each
time they visit the patient.
One of the domains of the NHS Outcomes Framework is personalised

care for people with long term conditions and at the end of life. A
multidisciplinary approach is strongly advocated, as well as the idea
that patients themselves will be developing their own personalised
care plans.
www.gov.uk/government/publications/improving-care-for-people-with-
long-term-conditions-at-a-glance-information-sheets-for-healthcare-
professionals
The multi disciplinary team can potentially consist of the following

professionals:
• General Practice Nurse
• District Nurse
• General Practitioner
• Practice Manager
• Physiotherapist
• Health Visitor
• Community Mental Health Team
• Speech and Language Therapist
• Occupational Therapist
• Dietitian
• Social Worker
• Health Care Assistants
• Pharmacists
• Palliative Care Nurse
• Counsellors
• Health coaches
• Health care navigators
Activity: Can you think of other people involved in the multi-

disciplinary team and identify why they are involved?
• Identify a patient registered with your practice and carry
out this exercise in any way that you are familiar with, e.g. spider
plan, post it notes, lists.
• If you are new to working in General Practice try to think of who
would be the key members of the multi-disciplinary team.
Case scenario
Mrs Brown has been attending the surgery for dressings to her wound
site following a mastectomy for breast cancer. She appears very low
in mood and has missed two of her recent appointments with you.
She says that she does not want to continue with any other medical
treatment following her surgery and is considering alternative therapies.
You are aware of the importance of the Multi-disciplinary team in

ensuring patient choice.
• What would you envisage your role to be in this situation?
• What areas of care can be provided by other members of the multi
‘There must be respect across all of the disciplines to foster a positive
environment.’
disciplinary team? know the patient well enough?
• Is there the potential for overlap of services?
• What can be done to prevent this happening? Possible action
• You could advise the patient to gradually increase
Possible action the amount of walking she does every day,
• You could call a meeting with the whole multi beginning with 5 minutes every hour increasing
disciplinary team, ensuring that you are allocating to half an hour twice a day
sufficient time to discuss the patient’s situation
with their consent • You could tell the patient that you will contact
• Care could be provided by the GP, DN, Macmillan the physiotherapist to visit to reassess them and
Nurse, Breast Cancer Nurse advise them not to mobilise more than they have
• There is potential for overlap of services if there to, e.g. visiting the toilet, walking into the kitchen
is no coordination. Therefore there should be a to prepare food. When the physiotherapist
key worker who will oversee the coordination of reassesses their mobility they will be given
services. further advice from the physiotherapist
Reflection trigger point – what would you • You could tell the patient to rest and to listen to
do if? their body and not to mobilise if it is uncomfortable
These reflection triggers are for you to get together
with your mentor and if appropriate other team • Discuss with senior nurse or GP
members to debate possible solutions. They could
be used as a basis for a discussion or even a teaching • Arrange another appointment to review the
session. We are aware that the solutions to these patient
triggers may vary from Trust to Trust, according to local
policy and procedure. We are also aware that there • Think of the impact your decision will have on the
may be no ‘right or wrong’ answers to how certain patient. Have you collaborated effectively with
situations might be tackled and therefore it will be for the correct person in the team?
you as a qualified nurse to apply your thinking within
the parameters of your own professional practice. General Practice Nurses’ Quotes
‘I enjoy working in a primary health care team and
• What is the role of the GPN when taking wound working with other professionals.’
swabs? Who is responsible for ensuring that the
results are acted upon? ‘…communicate with the team - no day or patient is
the same, open communication helps everyone.’
• You are working with another nurse who always
seems to be off loading her patients onto you, ‘….teamwork, holistic nursing and multidisciplinary
saying she is running late and patients have been working.’
waiting. What would you do?
• You are working with a colleague who seems to

Transition to
General
Practice
Nursing
Contents
Chapter Summary
This chapter has looked at the importance
Nursing?
arrive early at work and is always the last to leave

General Practice
of team work and collaborative ways of

development
groups
in the evenings. She seems to get very heavily

development
keeping up to date
working within a multi disciplinary team. It

involved with the patients she cares for and
stresses that all members of the multi-disciplinary
does not appear to appreciate any professional
team have a responsibility and all members of the
boundaries. What would you do?
team should be invited to participate in discussions
regarding their patients. If a multi disciplinary team
Consider if you are new to General Practice Nursing
is going to be effective there must be respect across
and a patient attends for removal of sutures following
all of the disciplines which will foster a positive
hip surgery. You notice that the patient is not
environment. The overall aim of collaboration is to
mobilising as well as she should be. What action
encourage health professionals to work together in
would you take?
the most effective and efficient way to produce the
best health outcomes for patients and for providers.
• Would you give the patient advice on mobilising?
This chapter has also highlighted the importance of
• Would you inform the physiotherapist ?
accurate record keeping, highlighting the fact that
• Would you take no action because you do not
verbal statements unsupported by documentary evidence carry less
weight in a court of law.
Web-links
• www.nmc.uk.org
• www.gov.uk
• www.comfirst.org.uk
• www.charity-commission.gov.uk
• www.eicp.ca/en
• www.cochrane.org
• www.eoecph.nhs.uk
• www.england.nhs.uk
Transition to
General
Practice
Nursing
Contents
Nursing?
General Practice
development
groups

development
keeping up to date
Chapter 7 - Working with Vulnerable groups
• Define vulnerability
• Identify various forms of abuse
• Raise awareness of systems that protect vulnerable people and
how to ‘raise concerns’.
Working as a General Practice Nurse you will meet all members of the
family. There are many similarities in definitions of vulnerability of these
groups; however there are some very distinct differences between
adults and children in terms of how these groups are managed. For this
reason this chapter has two parts, part one will concentrate on adults
and part two will concentrate on children.
Adult safeguarding
When working with vulnerable groups it is of paramount importance
that professionals are aware of both national and local policies for the
protection of their patients. Safeguarding is about acting in the best
interest of people who are receiving care in health and social care
domains. Remember, The NMC Code states: Professional standards of
practice and behaviour for nurses and midwives requires you to ‘raise
concerns immediately if you believe a person is vulnerable or at risk and
needs extra support and protection’ (p13) You must share information
if you believe someone may be at risk of harm while keeping to the
relevant laws and policies about protecting vulnerable people.
Definition
A person aged 18 years or older ‘who is or may be in need of community
care services by reason of mental or other disability, age or illness;
and ‘a person aged 18 years or older‘ who is or may be in need of
community care services by reason of mental or other disability, age or
illness; and who is or may be unable to take care of him or herself, or
unable to protect him or herself against significant harm or exploitation’
Department of Health (2009) Safeguarding Adults: report on the
consultation of the review of ‘No Secrets’.
You should have accessed adult and child safeguarding training during
your induction programme if not already up to date with mandatory
training. Department of Health (2011) Safeguarding Adults: The role
of health service practitioners, available online www.dh.gov.uk/
publications
As practice evolves, so does the need to develop understanding of

the terminology around risk and vulnerability. In more recent years the
term ‘adult at risk’ has replaced ‘vulnerable adult’. This is because the
term ‘vulnerable adult’ may wrongly imply that some of the fault for the
abuse lies with the abused adult (Social Care Institute for Excellence
2011). Under the new Protection of Freedoms Act (HM Government
2012) the definition of vulnerable has been redefined: ‘...adults are
considered vulnerable because of their age, behaviour, illness and other
characteristics. A person will now be considered vulnerable because of
the nature of the regulated activity being provided to them, regardless
of where or how often that activity takes place.’ (HM Government 2012
p54)
‘Nurses need to be aware that adult patients have the right to refuse
treatment even if it may be to their own detriment.’
Protection of Freedoms Act (2012) in areas such as employment, education and access
www.legislation.gov.uk/ukpga/2012/9/contents/ to services
enacted
• Safeguarding Vulnerable Groups Act (2006)
A further consideration when caring for patients is This Act makes provision for children and vulnerable
the right to dignity and choice and consent to the adults
care being given. Within the primary care setting
practice nurses need to be aware that adult patients • The Mental Capacity Act (Discrimination)
have the right to refuse treatment, even if it may be (2013)
to their own detriment, as the law recognises that This revised Act makes provision for people that
adults have the right to determine what is done to maybe discriminated against on the grounds of
their bodies. The Mental Capacity Act (2005) makes mental ill health. Here is the link to guidance on an
a presumption that the individual has the capacity amendment to the Mental Capacity Act 2005 with
to make decisions for themselves. All health care regard to Deprivation of Liberty: www.scie.org.uk/
professionals should assist people in making their publications/ataglance/ataglance43.asp
own decisions and recognise their freedom to make
unwise decisions. If a person has been assessed Within the UK the legal framework to protect children
as lacking capacity, any decisions made must be from abuse and neglect has a long history. However
in the person’s best interest and must be the least it was not until 2000 that England and Wales
restrictive of that person’s rights. Here is the link to developed a framework of policy guidance to protect
the Mental Capacity Act 2005 that you should read: adults. The approach to adult safeguarding is for one
www.legislation.gov.uk/ukpga/2005/9/contents of collaboration and strategic partnership between
all concerned. This was highlighted following the
Here is the Social Care Institute for Excellence (SCIE) serious case review of the death of Steven Hoskins
accessible guide to the Mental Capacity Act 2005: who was a vulnerable adult. Although Steven had
www.scie.org.uk/publications/mca/index.asp frequent contact with several agencies such as
primary care, the police, social services and the
Follow this link for further guidance on consent ambulance service, yet there was no communication
for examination and treatment: www.gov.uk/ between them. This led to a failure to identify how
government/uploads/system/uploads/attachment_ vulnerable he was to abuse by individuals he had
data/file/138296/dh_103653__1_.pdf befriended. The following video includes the findings
of the serious case review and the response of those
Here is some UK legislation that is in place to protect services involved.
vulnerable groups:
Social Care TV – link to Steven Hoskins case
• Human Rights Act (1998) w w w. s c i e . o r g . u k / s o c i a l c a r e t v / v i d e o - p l aye r.
The section on ‘other rights and proceedings is a s p ? g u i d = 5 5 E 3 A 2 3 3 - C 8 8 0 - 4 C B 4 - 8 7 01-
particularly related to Safeguarding. 4ACB9D243D39
• The Care Standards Act (2000) Department of Health (2000) No Secrets: Guidance
This Act makes provision for the registration and on Developing and Implementing Multi-Agency
regulation of public and private establishments. Policies and Procedures to Protect Vulnerable Adults
Section 3,7 and 9 particularly relate to community from Abuse (DH London).
nursing.
The safeguarding of adults and incidents of abuse in
• Race Relations Act (2000) health and social care settings appear in the media
This Act relates to discrimination of people on racial all too frequently. More recently the Francis Report,
grounds. which was the review following the Mid-Staffordshire
incidents, raised further questions in relation to
• Domestic Violence, Crime & Victims Act (2004) vulnerability and amongst many recommendations
Part 1 of this Act is particularly relevant to vulnerable stated that:
adults.
‘Patients must be the first priority in all of what
• The Disability Discrimination Act (2005) the NHS does by ensuring that, within available
This Act makes provision for people with disabilities resources, they receive effective care from caring,
compassionate and committed staff, working within a common culture,
and protected from avoidable harm and any deprivation of their basic
rights.’ The Francis Report (2013) www.midstaffspublicinquiry.com/
report
What is abuse?
It is important to have some
understanding of how to
recognise forms of abuse:
• Physical - hitting , slapping,

kicking, pushing. In healthcare
this could be forms of restraint
or misuse of medication. This
includes those who may be at
risk of female genital mutilation
(FGM)
• Sexual - rape, assault

or sexual acts that are not
consensual or where the
person has been pressured
into consent
• Psychological - emotional
abuse, threats of harm, abandonment or withdrawal, deprivation
of contact, humiliation, intimidation, blaming, controlling and verbal
abuse
• Financial – theft, fraud, exploitation, pressure over wills, property or

inheritance
• Neglect or acts of omission- ignoring medical or social needs, failure

to provide access to appropriate health or social care. Withholding
medication or nutrition
• Discriminatory - racists, sexist abuse and exploitation due to

disability.
Adapted from Action on Elder Abuse (2006)
Duty of Care
As already stated, all nurses under the NMC Code (2015) have a duty
of care to protect vulnerable groups. As part of their role and ‘duty
of care’ General Practice Nurses are required to be up to date on the
changes implemented under the Protection of Freedoms Act (2012). In
particular the Act defines ‘regulated activity’ with vulnerable groups.
This requires all health care professionals to undergo a Disclosure and
Barring Check for any new employment.
It is your responsibility as a General Practice Nurse to act promptly if

you have any concerns. Duty of Care means:
• To act to protect the adult at risk
• To deal with immediate needs, as far as possible, central to the
decision making process
• To report any concerns. Do not feel you are alone, you will have
support to make referrals where needed. Talk concerns through
with your line manager.
‘Safeguarding children is everyone’s responsibility.’
• To contact the local safeguarding lead for (NSPCC) (2010) are listed as:
advice. They will advise if police involevement is
necessary if you think a criminal act is involved • Physical
• To accurately record the incident • Sexual
• To follow up your concerns • Emotional
• Neglect.
Here are two resources that may assist you:
NMC (2010) Raising and escalating concerns – step It is important to consider what behaviours happening
by step guide: www.nmc-uk.org/Documents/NMC- within a family could be seen to be causing or likely to
Publications/NMC-Raising-and-escalating-concerns. cause significant harm to any child within that family
pdf or who may spend time within the house or be cared
for by family members.
RCN (2010) Raising concerns document
www.rcn.org.uk/support/raising_concerns When to Suspect Child Maltreatment (NICE 2013)
provides guidance for recognition of both physical
Multi agency practice guidelines on FGM: and psychological symptoms. It is important to
www.gov.uk/government/publications/female- remember that the impact of abusive behaviours and
genital-mutilation-guidelines neglect will be dependant on age, resilience and other
support networks available. Support from family
Activity: Make sure you know who your members may be limited when they are dealing with
in-house and local safeguarding contacts are chronic illness or potential bereavement.
so that you are prepared should the need arise.
It has been recognised that early intervention is
Child Protection extremely important to reduce negative long term
It is recognised that all staff working in health care effects (Munro 2011). This means that prompt referral
settings, even when their client group is mainly adult, to appropriate agencies are essential. Nurses are
should receive appropriate training in matters of child often concerned that by discussing clients they might
protection (RCN and RCPCH 2012). be breaching confidentiality, but the safety of the
child is paramount. Information sharing: Guidance
Safeguarding children is everyone’s responsibility for practitioners and managers (DfCS 2008) supports
and to ensure that services are available to children those working in both child and adult services to work
in need or at risk of harm, every professional and effectively to safeguard children. Working closely
organisation must be mindful of their responsibilities with GPs , Health Visitors and School Nurses is key to
and process of appropriate referral. Although General ensuring the best outcomes. The local Safeguarding
Practice Nurses provide care for predominately adult Nurse for children will also provide guidance and
clients, they are closely involved with families and advice in any situation.
have frequent contact with children, for example for
immunisations and in asthma clinics. Over the last years, the impact of domestic abuse
within families has been recognised and the need to
Chronic illness, issues of deteriorating mental health minimise its long term effects on developing children
and loss and bereavement have a significant impact has been prioritised. General Practice Nurses should
on family dynamics and the emotional well-being of be mindful that abusive situations involving adults will
all the family. It is therefore possible that concerns be also impacting on any children within the family
regarding the welfare of a child may be recognised and this will place the child at risk. Consider who has
initially by a practitioner in the surgery or that the ‘Parental Responsibility’ and ensure you understand
family may disclose their own worries. The child what this means:
may also express concerns or raise issues with the www.gov.uk/parental-rights-responsibilities/what-is-
GPN directly. Remember the practice team are not parental-responsibility
responsible for investigating child abuse and neglect,
rather for the sharing of concerns and information The number of young carers in the UK is also growing
appropriately. and they may spend up to 50 hours a week caring
for parents or other family members. The impact on
Categories of abuse as defined by the National their social life and educational achievement can be
Society for the Prevention of Cruelty to Children considerable. They will often be reluctant to relinquish
their caring role or discuss with their teachers and
they may need help to access services and organisations who can
provide them with appropriate support and respite.
The QNI has developed a free online resource specifically for nurses
working in general practice, to enable them to work effectively
with carers who are supporting friends or family: www.qni.org.uk/
supporting_carers/general_practice_resource
Reflection trigger point

These reflection triggers are for you to get together with your
mentor and if appropriate other team members to debate possible
solutions. They could be used as a basis for a discussion or even a
teaching session. We are aware that the solutions to these triggers may
vary from practice to practice according to local policy and procedure.
We are also aware that there may be no ‘right or wrong’ answers to
how certain situations might be tackled and therefore it will be for you
as a qualified nurse to apply your thinking within the parameters of your
own professional practice.
Case study 1
A four year old boy’s mother attends for advice on managing his eczema.
She confides that his itching is always worse when his father is around
and that his father has an awful temper.
• What are your main concerns in this situation?

• Who might you want to share this information with?
• To whom would you go for guidance?
Case study 2
A 15 year old girl attends your practice asking for family planning advice
• Do you have any concerns about giving such advice?

• What legislation should you refer to?
• What are your possible actions?
• When we are trying to decide whether a child is mature enough to
make decisions, people often talk about whether a child is ‘Gillick
competent’ or whether they meet the ‘Fraser guidelines’
• Remember the concept of ‘Gillick Competence’ that children under
16 years of age with sufficient understanding and intelligence may
consent to treatment. However when this relates to contraception, or
the child’s sexual or reproductive health, the healthcare professional
should try to persuade the child to inform his or her parent(s), or
allow the medical professional to do so.
• www.nspcc.org.uk/preventing-abuse/child-protection-system/legal-
definition-child-rights-law/gillick-competency-fraser-guidelines/
• www.gov.uk/government/uploads/system/uploads/attachment_
data/file/138296/dh_103653__1_.pdf
References
• Department for Children, Schools and Families (2008)Information
Sharing: Guidance for practitioners and managers. London.
Stationery Office.
• Her Majesty’s Government (2013) Working Together to Safeguard
Children. A guide to inter-agency working to safeguard and promote
the welfare of children. London. Stationery Office.
• National Institute for Health and Clinical Excellence (2013) When to
suspect child maltreatment. NICE Clinical Guideline 89. London.
NICE.
‘This topic is complex and specialist and all professionals need to
work collaboratively so that any risk is managed sensitively.’
• NMC (2015) The Code: Professional standards of
practice and behaviour for nurses and midwives
London. NMC
• NSPCC Inform (2010) Child Protection Fact Sheet.
The definitions and signs of child abuse. London.
NSPCC.
• Munro, E (2011) The Munro Review of Child
protection: A child-centred system. London.
Department for Education.
• Royal College of Nursing and the Royal College
of Paediatrics and Child Health (2012) Looked
after children: Knowledge, skills and competence
of health care staff. Intercollegiate framework.
London. RCN and RCPCH.
• Department of Health (2000) No Secrets:
Guidance on Developing and Implementing
Multi-Agency Policies and Procedures to Protect
Vulnerable Adults from Abuse DH London
Transition to
Chapter Summary
General
Practice
Nursing
Contents
Nursing?
This Chapter focused on two different

General Practice
development
groups
vulnerable groups that you will encounter


development
keeping up to date
and raised awareness of the legalities of a

professional’s responsibility when caring for these
groups. It has discussed what may be considered
to be harm, abuse or neglect and also ways of
detecting signs of abuse. It has also suggested ideas
of how you may report or raise your concerns when
protecting the people you encounter in your role.
It is acknowledged that this topic is complex

and specialist and all professionals need to work
collaboratively so that any risk is managed sensitively.
Web Resources
• www.cpa.org.uk Centre for Policy on Ageing
• www.cqc.org.uk Care Quality Commission
• www.jrf.org.uk Joseph Rowntree Foundation
• www.ncb.org National Children’s Bureau
• www.scie.org.uk Social Care Institute for
Excellence
• www.saarih.com Safeguarding Adults at Risk
Information
• www.gov.uk/government/uploads/system/
uploads/attachment_data/file/417412/Reference_
Guide.pdf Reference Guide to the Mental Health
Act 1983

Transition to
General
Practice
Nursing
Contents
Nursing?
General Practice
development
groups

development
keeping up to date
• Consider the role of the carer and the legislation relating to the
assessment and support that should be available to carers of adults
• Explore the role of the General Practice Team in supporting carers
• Look at ways to enhance the carer experience.
The role of the carer

When discussing caring for the adult at home it would be impossible
to discuss care without recognising the role of informal carers. Carers
provide unpaid care by looking after an ill, frail or disabled family member,
friend or partner. Most of us will look after an elderly relative, sick partner
or disabled family member at some point in our lives. However, whilst
caring is part and parcel of life, without the right support, the personal
costs of caring can be high (Carers UK 2012).
Carers act as expert care partners in providing high quality care and
make valuable contributions to social services and NHS service
providers. There are an estimated 6.4 million carers in the UK today and
an expected increase of 40% in the number of carers needed by 2037.
The financial impact and value of this care is estimated at £87 billion
per year (Carers UK 2012). Up to 1 in 10 of your patients will be carers.
This informal workforce, who provide significant amount of unpaid care,
may not be able to meet the demand, leaving a significant ‘care gap’
(Kings Fund 2012). It is for this reason that the carer and the general
practice nurse should develop a partnership to ensure the well-being of
the carer as well as the well-being of the patient.
The National Carers’ Strategy published in 2008 set five outcomes to

be achieved by 2018, so that carers will be:
1. Recognised and supported as an expert care partner
2. Enjoying a life outside caring
3. Not financially disadvantaged
4. Mentally and physically well, treated with dignity
5. Children will be thriving, protected from inappropriate caring roles.
The Care Act 2014 outlines how local authorities should carry out carers’
assessments and needs assessments. It is mainly for adults in need of
care and support and their adult carers. In April 2015 most of the Care
Act came into force. Carers UK has developed a FAQ sheet:
www.carersuk.org/help-and-advice/practical-support/getting-care-and-
support/care-act-faq
NHS England has also published its commitment to carers to give them
the recognition and support they need to provide invaluable care for
loved ones: www.england.nhs.uk/ourwork/pe/commitment-to-carers/
It is imperative that important issues such as carer identification,

assessment and education and partnership working are acknowledged.
Carers have a tendency to not pay attention to their own health needs and
are categorised as a high risk group for health problems (Simon 2011).
‘Whilst caring is part and parcel of life, without the right support, the
personal costs of caring can be high.’
The role of the health and social care professional is General Practice Nurses quotes about
to be able to carry out carer assessments in order
carers
to fully understand the carers’ experiences and then
‘…building up a rapport with patients and getting
to implement strategies in order for carers to feel
positive feedback from them and their relatives is
supported in care delivery (Chilton et al 2012).
very satisfying.’
Overall the carer plays a significant role in keeping the
Nurses recognise that without carers looking after
patient at home and preventing hospital admissions.
their loved one it would be nearly impossible to carry
out their role as well as they do now as there would
The role of General Practice Team in be a much larger drain on the community nursing
supporting carers workforce. However, there is the danger that nurses
Being a carer can impact negatively on the care can expect too much of the carer, which in turn can
giver’s own health. The role of those working in lead to ill health in the carer.
General Practice is to identify their needs, their own
health status and what might be required in order to Due to the multicultural nature of UK Society you will
ensure they are able to continue in their caring role. meet people from diverse communities with varying
GPNs are well placed to provide support to carers beliefs and expectations about health. A study carried
and there are great opportunities for joint working out in 2007 claimed that 17.5% of carers were of
with social services and other agencies to meet the an ethnic minority background. Working with these
physical, social and emotional needs of carers. carers will require sensitivity in planning and sharing
the care as many people from a minority ethnic
The Quality and Outcomes Framework includes background see caring as their duty and often will not
identification of carers of people with dementia and have requested the services of professional nursing.
encourages health screening in this group through Diplomacy in working with such groups is essential
an enhanced service. The Royal College of General as the aim is to work together to give patient and
Practitioners together with The Carers Trust has carer the best possible support.
published ‘Supporting Carers - An action guide for
General Practitioners and their teams’ As mentioned in Chapter 7, the number of young
www.rcgp.org.uk/clinical-and-research/clinical- carers in the UK is growing and young carers may
resources/carers-support.aspx spend up to 50 hours a week caring for a member
of their family. This will have a significant impact
They suggest as a first action that carers registered on their social skills as well as their educational
with the practice should be identified. needs. This group of carers will require support that
is meaningful to them and support offered should
Reflection point promote confidence that those being cared for by
• How many patients do you have on them will not be disadvantaged if they take up some
your practice list? additional support. Working with this group of carers
• How many carers would you expect to have on will require an element of emotional intelligence
your practice list? (Divide your practice list size by which is mentioned in Chapter 10.
10 to give an estimate)
• Amongst every 100 patients on your practice list, Enhancing the carer’s experience
you would expect 10 to be carers; 3 or 4 to be Five key ways for GPs and primary care teams to
caring for more than 20 hours a week and 2 to be support carers have been identified:
caring at least 50 hours a week.
• Listen to the carer
How else could you identify carers? • Think of depression and other ill health
Possible actions: • Tactfully ask about finances
• Search for certain conditions for patients who are • Signpost to appropriate services
likely to require a carer e.g. stroke or dementia • Plan for emergencies.
• Ask patients who are registering with your
practice whether they have caring responsibilities General Practice Nurses should be alert to the
• Check hospital discharge letters for events that possible effects of the stress and worry of having
are likely to result in a relative having a caring caring responsibilities and have a role in screening
responsibility. carers for signs of depression and self harm behaviour
such as the misuse of alcohol. Practices are encouraged to identify
carers and maintain good records of contact details and nominated
carers so that they can be included in care planning.
It is important to know where to refer carers for further assessment

or support if necessary. Consider a local directory of resources and
services such as local support groups, community mental health teams
or Citizens Advice Centres for financial advice.
• The Carers Trust, www.carerstrust.org, is a charity which is the

merger of Crossroads Care and The Princess Royal Trust for Carers.
There is a wealth of information on the site about how carers can
apply for respite care as well as information on education and
finance
• www.hscic.gov.uk This site will give you information on topics

related to health and social care.
• There may be local organisations that you can access. These may
be voluntary, private or charitable organisations, your team can
guide you with this.
• The QNI has developed a resource to enable General Practice

Nurses to support carers http://qni.org.uk/supporting_carers/
general_practice_resource
Case scenario - Patient and Carer Focus

Margaret has Dementia and has been referred by home care with a skin
tear due to a fall. She is cared for by Henry, her 75 year old husband,
who has diabetes and reduced mobility. While assessing her Henry
asks if Margaret should have a urinary catheter as she has started to
become incontinent and he is finding it difficult to manage.
• Explore issues such as carers needs – does Henry need an

assessment himself?
• What support is in place for carers?
• Are there any ethical implications?
• Risk assessment
Possible actions :
• You could refer Margaret to the District Nurse for assessment for a
urinary catheter
• Refer to continence service for an opinion as better continence aids
could resolve this
• You could arrange for Henry to have some social support in the
form of extra help in the morning and evening which would reduce
the amount of times that Henry would have to deal with Margaret’s
toileting
• Referral to local memory clinic via GP
• When considering ethical implications what are you looking at?
Are you thinking of what is the best action for Margaret or Henry?
Should both needs be considered?
Some areas to be considered when carrying out a risk assessment are

as follows:
• Is Margaret able to recognise when she needs to go to the toilet?
• Is Margaret capable of making her own way to the toilet?
• Is the home environment suitable for a commode?
‘Without carers there would be many more hospital admissions.’
• Where would you place the commode in the • QNI GPN carers resource http://qni.org.uk/
home? supporting_carers/general_practice_resource
• What amount of fluid intake is Margaret having • www.rcgp.org.uk
daily? • www.carersuk.org
• What times of the day does she drink? • www.ageuk.org.uk
• Is there a particular time of day when Margaret • www.youngcarers.net
is incontinent? • www.macmillan.org.uk
• Is Henry able to monitor his own diabetes? • www.carersinthecommunity.org.uk
• What is Henry’s nutritional status? • www.healthknowledge.org.uk
• What are the restrictions to Henry’s mobility? • www.communitycare.co.uk/
• Is Henry’s restricted mobility a danger to both articles/16/08/2011/46026/carers.htm
Henry and Margaret? • www.crossroadscare.co.uk
• www.nhs.uk/CarersDirect
These are just some of the risk factors to consider. • www.gov.uk/government/organisations/
Can you think of more? • www.gov.uk
Transition to
General
Practice
Chapter Summary
This chapter has looked at the important role
Nursing
Contents
Nursing?
that carers play in supporting the primary care

General Practice
development
groups
and community service teams to look after a

development
keeping up to date
large number of vulnerable people being cared for

at home. The partnership between the carer and the
General Practice Nurse is essential if care is to be
ongoing. However, it was also recognised that often
carers could be taken for granted and therefore there
must be acknowledgement of the amount of work
that carers do in preventing hospital admissions. The
diversity of patient needs due to cultural diversity
was also addressed.
It is mainly District Nurses who highlight issues in

the home and problems those carers and patients
may be facing. But patients who are able to get to
the surgery require the GPN to have an awareness
and ask appropriate questions to help establish if
there is any unmet need.
Some carers will become quite agitated if they have

to wait for their appointment in the surgery, as they
are anxious that their loved one is coping at home
without them. This is particularly so in the case of
carers for patients with Dementia. This anxiety often
alerts GPN, or GP, to the problems at home.
Overall this chapter has highlighted that without carers

there would be many more hospital admissions, as
there are limited community resources to maintain
care in the community without the addition of these
numerous unsung heroes.
Web resources
Transition to
General
Practice
Nursing
Contents
Nursing?
General Practice
development
groups

development
keeping up to date
Section C - The future - personal and
professional development
Chapter 9 - The policy context and keeping up to date
• Raise awareness of the political climate in which the NHS now
exists
• Consider the future for General Practice nursing
• Explore some of the impact these changes will have on practice
• How do you keep up to date?

In today’s NHS there are many changes that will impact on the way in
which primary care nursing is delivered and as a nurse you will need a
working knowledge of what these changes will mean to you in your role.
We will now look in turn at the Department of Health (DH), the Royal
College of General Practitioners (RCGP), The Queen’s Nursing Institute
(QNI) and Royal College of Nursing (RCN) and their interpretation of
some of the changes.
The Department of Health

The NHS faces a period of change both in terms of demographic changes
and the shifting burden of disease, requiring the reassessment of the
hospital based model of care (Commons of Health Select Committee
2012). The Department of Health’s Structural Reform Plan recognised
the shift of resources and emphasised care out in the community and
it also highlighted the need to adjust working practices and roles to
promote better healthcare outcomes (DH 2010a). The reconfiguration
of the workforce and altering the point of service delivery has become
essential. This redistribution from hospital based provision represents
a need to enhance the delivery of care in the community setting. The
need to make long-term cost savings whilst attempting to maintain and
enhance the quality of services is paramount.
This expansion of community services and the emphasis on care closer

to home resonates in many recent government and policy reports.
With an ageing population and increased prevalence of disease there

will need to be a move away from the current emphasis on acute
and episodic care towards prevention, self care and more consistent
standards of primary care to care that is well co-ordinated and integrated
(King’s Fund 2011).
Close to Home (DH 2011) was an inquiry into older people and their
human rights in home care. It was the first inquiry of its kind and it
uncovered some real concern in the treatment of some older people,
especially when examining how some services were commissioned.
Its key findings highlighted neglect around delivery of care packages,
financial abuse and a chronic disregard for older people’s privacy and
dignity. Whilst this report concentrated on older peoples experiences
of receiving social care in the home setting, its findings were far
reaching in terms of the infrastructure and systemic problems related
to promoting human rights in the home care setting.
‘There has also been a need to return to the fundamentals of nursing
which have been characterised in the 6 ‘Cs’.’
The Five Year Forward View Report You can also follow nurse leaders such as the Chief
The Five Year Forward View was published in October Nursing Officer England and Director of Nursing
2014 and sets out the current vision for the future for the Department of Health as well as specialist
of the NHS. It has been developed by the partner advisors for Practice Nursing.
organisations that deliver and oversee health and
care services including NHS England, Public Health Hashtags to follow:
England, Monitor, Health Education England, the Care • #6Cs
Quality Commission and the NHS Trust Development • #Caremakers
Authority. The purpose of the Five Year Forward View
is to explain why change is needed, what that change ’Compassion in practice’ is a strategy for developing
might look like and how we can achieve it. It describes a culture of compassionate care in nursing that was
various models of care which could be provided in published in 2012 by the Chief Nursing Officer and the
the future, and defines the actions required at local Director of Nursing at the DH, following an 8 week
and national level to support delivery. It covers areas consultation with over 9,000 nurses, midwives, care
such as disease prevention; new, flexible models staff and patients. www.commissioningboard.nhs.
of service delivery tailored to local populations and uk/nursingvision
needs; integration between services; and consistent
leadership across the health and care system. www. The Shape of Caring Review led by Lord Willis was
england.nhs.uk/ourwork/futurenhs published early in 2015 and aims to ensure that
throughout their careers nurses and care assistants
The Five Year Forward View reinforces the need to receive consistent high quality education and training
change the way care is delivered, based not only on that supports high quality care over the next 15 years.
financial considerations but changing health and social
care needs. The foundation of NHS care will remain It brings together findings and expertise from recent
in primary care but new partnerships between health major reports and promotes good practice from
services, local communities, local authorities and across the country relating to the education and
employers will need to be developed. An upgrade training of care assistants and nurses. Among the
in prevention and public health is proposed and new main themes are those of valuing the care assistant
models of out of hospital care suggested such as and widening access for them to enter nursing. This
integrated hospital and primary care providers. These includes the previously mentionned Talent for Care
changes are consistent with the need to develop and strategy and the introduction of the Care Certificate.
expand the GPN workforce who are ideally skilled The review outlines suggestions for changes to
and placed to contribute to this agenda. the structure of nurse training that will promote
community nursing and include the provision of
The nursing profession has evolved in line with placements in general Practice for nursing students.
changing disease patterns, new treatments and https://hee.nhs.uk/work-programmes/shape-of-
different service delivery. There has been a need caring-review/
to develop new knowledge and skills, accept more
responsibility and accountability and create robust The Royal College of General
education opportunities. However, there has also Practitioners (RCGP)
been a need to return to the fundamentals of nursing The RCGP has also published its vision of the National
which have been characterised in the 6 ‘Cs’. This Health Service in 2022. It acknowledges that the
has been characterised within the DH Strategy health needs of our population are changing, with an
for Nursing 6 Cs care, compassion, competence, ageing population in which an increasing number of
communication, courage and commitment www. people have multiple long-term conditions.
england.nhs.uk/wp-content/uploads/2012/12/6c-a5-
leaflet.pdf Healthcare professionals will need to develop a
range of generalist skills in order to meet the needs
There are various ways to get involved in 6C’s Live. of patients with a growing range of long-term
conditions. General Practice Teams are uniquely
Twitter accounts to follow: placed to develop and incorporate their ‘whole-
• @WeGPNs person’ understanding of the patient and their family;
• @6CsLive to manage risk safely and to share complex decisions
• @nhsb with patients and carers, while adopting an integrated

approach to their care.
The RGCP anticipates the need for integrated, community-shaped,

generalist healthcare services with a greater number and diversity of
skilled, generalist-trained professionals, able to care for patients in their
homes and communities.
As a result they envisage that practice teams will require the skills
and expertise of nurses, physician assistants and other professionals
who have undergone specific vocational training in community-based
settings and are trained for their generalist role, which will complement
that of the General Practitioner. Their unique skills will include prescribing
and advanced nursing skills in order to help deliver care for patients
within the practice and wider federated organisations of practices and
healthcare providers.
GP Commissioning
You will need some understanding of GP Commissioning and its
potential impact on patient care. This clip is a useful introduction:
www.nuffieldtrust.org.uk/talks/videos/clare-gerada-commissioning-
impact-patient-care?gclid=CI2a8dHvg7cCFcXKtAodLG8A1A
You can also read about current issues with The New NHS - Clinical
Commissioning groups by visiting the following link: www.kingsfund.
org.uk/projects/new-nhs/clinical-commissioning-groups?gclid=CNCZ0e
Dwg7cCFTMRtAodYzYAsA
From April 2013 the NHS Outcomes Framework has formed part of the
way in which the government will hold the new NHS Commissioning
Boards to account. The NHS Outcomes Framework 2014/15:
• Explains the purpose of the NHS Outcomes Framework and how it

will work in the wider system;
• Highlights the main indicator changes across each of the five domains.
Domain 1 - Preventing people from dying prematurely
Domain 2 - Enhancing quality of life for people with long-term

conditions
Domain 3 - Helping people to recover from episodes of ill health or

following injury;
Domain 4 - Ensuring that people have a positive experience of care;
Domain 5 - Treating and caring for people in a safe environment; and

protecting them from avoidable harm.
www.gov.uk/government/publications/nhs-outcomes-framework-2013-to-2014
The Queen’s Nursing Institute (QNI) interest. Anyone can contribute to policy consultation
The QNI carried out an extensive survey of patients documents either as individuals or groups and this is
and carers’ experiences of being cared for in the crucial in raising the profile of community nursing.
home in 2011. This resulted in the report ‘Nursing
People at Home - the issues, the stories, the actions’ Activity 1
(QNI 2011). The findings highlighted three things that What impact do you think GP Commissioning
patients said they wanted from community nurses: will have on patient care? Consider the advantages
they want them to be competent, confident and and disadvantages.
caring. This theme was the start of the larger DH
strategy launched in December 2012 (DH 2012a). Activity 2
Choose a topic that interests you or a topic
The case for integrated care has never been stronger that you know very little about, either must relate to
with the ageing population and increased prevalence General Practice Nursing.
of chronic diseases. Care for people with complex
health and social care needs must be made a real • Search on the DH, The QNI, RCN ,Kings Fund or
priority with commissioners and providers (King’s any other related website for information
Fund 2011). The new model of integrated community • Look at any resources you may have in your clinic
care that focuses on prevention of ill health as or local surgeries
opposed to treating people when they become ill is • Access all the related websites that are attached
viewed as forward thinking. This integrated model to this resource that may assist your search
will require all key stakeholders to work in partnership • Start to compile an information file of your topic.
in the co-ordination of this care. A network of primary Transition to
General
Chapter Summary
Practice
care providers that promote and maintain continuity

Nursing
Contents
Nursing?
of care and act as links for the provision of chronic

This chapter has introduced the importance

General Practice
development
groups
disease management and generalist care (Holland

of understanding the government NHS

development
keeping up to date
and McIntosh 2012). reforms and other related literature and their impact
on primary care. The emphasis will be on GPNs to
How do I keep up to date? be involved in service planning and the work of the
Keeping up to date is a requirement of the NMC Clinical Commissioning Groups. In order to do this
registration. You are required to maintain currency they will need to be up to date and politically aware
in your field of practice to ensure that best evidence of how the changes will affect the delivery of primary
based practice is maintained and the public protected care services.
(NMC, 2015). It is also crucial given the rapidly
changing NHS that all nurses monitor changing policy Web Resources
and respond appropriately. • www.evidence.nhs.uk NHS Evidence database
• www.kingsfund.org.uk The Kings Fund
One method of keeping up to date is to perform • www.nice.gov.uk
a literature search of a particular topic of interest
related to your practice.
The purpose of a literature search:

• It broadens your knowledge on a topic
• Increases your general knowledge, specialist
knowledge, vocabulary and confidence
• Shows your skill in finding relevant information.
Contributing to consultation documents should also

be an important aspect of the community nurse
role. This means signing up to relevant professional
forums such as the RCN or The QNI and ensuring
that you are on relevant e-mailing lists. Your practice
managers will be on circulation lists from different
organisations, such as government departments.
Make sure that anything is forwarded to you that is of

Transition to
General
Practice
Nursing
Contents
Nursing?
General Practice
development
groups

development
keeping up to date
Section C - The future - personal and
professional development
Chapter 10 - Developing your career in General Practice
Nursing
• Consider your confidence and competence in community nursing
• Start to consider your own personal development plan
• Career planning
• Importance of Continuing Professional Development (CPD)
What is the purpose of continuing professional development? The overall

aim of CPD is to give all those working with patients the opportunity to
update their knowledge and skills in their area of work. For those who
are qualified nurses, it is an NMC requirement that at least 40 hours of
learning activity relevant to their practice is carried out over a three year
period. All qualified nurses must keep a portfolio which is updated on a
regular basis, and at least every time a new learning activity has taken
place. There is no point just putting together a portfolio of handouts,
power points, leaflets and certificates of attendance. This will of course
prove that you have attended an update, but it will not demonstrate what
you have actually learnt. It is therefore recommended that a reflective
account is written following each study day that you attend. Remember
you will be required to include 5 reflections on practice that you have
discussed with a NMC registrant as a requirement for revalidation.
http://www.nmc.org.uk/standards/revalidation/learning-training-and-
sharing-good-practice/
Attending study days is also an opportunity for you to develop your

professional skills and knowledge and may motivate you to continue
further education in specialist areas. There may be study days on travel
health, child immunisaitons,, tissue viability, chronic obstructive airways
disease, diabetes, tuberculosis, public health – the list is endless.
The Standards for Specialist Education and Practice (NMC, 2002)

incorporates the exercising of higher levels of judgment, discretion
and clinical decision-making in clinical care to enable the monitoring
and improvement of standards of care through supervision of practice,
clinical audit, the development of practice through research and
teaching, the support of professional colleagues and the provision of
skilled professional leadership (Boran 2009). In 2004, the NMC created a
third part of the professional nurse register for all Specialist Community
Public Health Nurses that included General Practice Nursing, School
Nurses, Health Visitors and Occupational Health Nurses.
Many Higher Education Institutions and organisations such as the

RCGP also offer a variety of validated specialist modules suitable for
the General Practice Nurse such as the Management of Long Term
Conditions.
The Health Care Assistant (HCA) role has been introduced into General
Practice over the past ten years and this body of staff need to engage
in the educational process in order to enhance their practice. The
Care Certificate was launched in April 2015 and it is expected that
every HCA will develop the core standards in the first 12 weeks of
their employment. As stated previously ‘The Shape of Caring Review’
‘There has also been a need to return to the fundamentals of nursing
which have been characterised in the 6 ‘Cs’.’
(2015) recognises that the HCA role is crucial in care team, working as part of a social enterprise or
health care and that HCAs must be valued and working with a specialist team of health workers. You
encouraged to develop professionally. This may be in will know what your specific interests are, so spend
the form of access to higher awards, apprenticeships time working through this site.
and access to Foundation degrees in health and
social care as a pathway towards progression into A number of Health Care Assistants also work as
nursing. An example of HCA competencies for part of a primary care team and they also should be
general practice can be found http://www.rcgp.org. involved in continuing professional development.
uk/membership/practice-team-resources/~/media/ Whilst they are not accountable to a professional
F2CFF4485F3E40739BD9C3A27048CBF2.ashx body, they still have their own individual integrity
and individual responsibility to ensure that they are
Band 5 and 6 practitioners, who may prefer to practice working as a safe practitioner.
in more generalist roles in primary care are being
encouraged to follow new educational programmes, It is imperative to know what your level of knowledge
aimed at enhancing clinical skills, knowledge and is if you are to work within your competence. Look at
competencies of the support staff workforce Boran
(2009).
For example, since 2011 Buckinghamshire New

University has offered a module in ‘Transition to
Community Nursing’ for community staff nurses. This
acknowledges that practitioners are often working
alone in environments that are not set up as health
care environments, needing to be able to transfer
their skills and dealing with complex collaborative
relationships with both clients and families, and also
with health, social and voluntary agencies. Nurses
working in primary care settings also need to be
able to make more autonomous decisions than their
hospital based colleagues (Drennan and Davis 2008).
the diagram below. Where would you place yourself
These workforce developments will require more on the ladder of competence?
GPNs to become mentors as they will need to have
the skills and knowledge to be able to support their Level1 – Unconscious Incompetence – You don’t
colleagues in their development. The NMC have know that you don’t know
Standards to support learning and assessment in
practice that may be found here: www.nmc.org.uk/ Level 2 – Conscious Incompetence – You know that
standards/additional-standards/standards-to-support- you don’t know
learning-and-assessment-in-practice
Level 3 – Conscious Competence – You know that
Taking on a recognised mentorship course will you know
prepare you to work as a supervisor or mentor in
practice, this will become an increasingly important Level 4 – Unconscious Competence – You don’t
role with the introduction of community placements know that you know – it just seems easy !
in General Practice for Pre-Qualifying Student Nurses.
Using this ladder as a tool will assist you in identifying
Reflections where more learning needs to take place, but it will
• If you were to contemplate a career also give reassurance when you are competent.
in the community what options are available to
you?
• What is your view of NHS careers for primary
care nursing?
www.nhscareers.uk This website highlights the
various nursing opportunities that are available,
whether it be working as a member of a primary
You may be aware of Benner’s
model that describes how during
the acquisition and development of
a skill, a nurse passes through five
levels of proficiency: novice, advanced
beginner, competent, proficient, and
expert. This model may help you and
your mentor to identify those areas of
skill and knowledge requiring further
development.
Benner, P. (1984). From novice to

expert: Excellence and power in clinical
nursing practice. Menlo Park: Addison-Wesley.
The following webpage, www.mind.tools.com/pages/article/newISS-

96htm introduces you to a number of leadership and management
strategies which you might find useful when you identify which level
on the above ladder you sit. Please remember that leadership and
management not only happens in senior management positions, but
every member of a team will have some leadership role to play.
Activity
Having identified where you are on the ladder, what action are
you going to take to change your position on the ladder?
Also acknowledge that you may be at different levels of competence
depending on what skill or subject matter is being addressed.
You may find the exercise uncomfortable because it displays areas
where you possibly thought you were more competent than you
actually are. This is not a problem as long as you are aware of this and
demonstrate an emotional intelligence that is resilient and will assist
you to develop/strengthen in these areas: www.mind.tools.com.
This website, www.emotionaliq.org/EI.htm will introduce you to

emotional intelligence and the different models used. Emotional
intelligence is the ability to perceive emotions in yourself, and in others.
Having recognised this it then enables you to identify strategies that
will help you to reflectively regulate emotions to promote emotional
and intellectual growth (Mayer & Salovey, 1997).
Personal Development Plan

What is required of a personal development plan? A development plan
is designed to help you to reflect on your career to date and for you to
put together a SMART action plan to assist you to reach your next goal.
There are three key stages in working on a personal development plan:
1. Identify what is required of your current role

2. Carry out a SWOT analysis – look at the strengths, weaknesses,
opportunities and threats that have assisted/prevented you working
effectively in your current role and also when considering future
roles
3. Develop a SMART action plan to assist you to move forward in the
direction of your chosen career.
Activity
Have you considered any other community career paths you
may want to follow – e.g. Specialist Nurse, Community Matron?
What steps/actions do you need to take to follow your chosen career
pathway? www.worldwork.biz/legacy/www/ practice? Do you feel more confident now? Are you
downloads/Personal_Development_Plan.pdf going to pursue your studies further?
A personal development plan will help when you
attend interviews and will also assist you when Transition to
General Chapter Summary
writing your CV, as it will have outlined clear objectives
Practice
Nursing
This chapter has looked at the importance of

Contents
Nursing?
in your SMART action plan.

General Practice
recognising your individual competence in the

development
groups

role you are currently working in. It has given

development
keeping up to date
Applying for jobs some recognition to how you can recognise your
Firstly, find out background information about the level of competence. This can really only occur if the
organisation: whether it is a NHS Trust or a Social individual concerned has a self awareness that will
Enterprise, charity or private company. Information enable them to act on their incompetence and put a
can be found on the website. Find out what their strategy in place to deal with this.
vision and strategy for the future is. What skill set
are they looking for – do you have the skills they are The career pathway for working in General Practice
looking for? It is essential that the job description was looked at, recognising that not all staff nurses
is scrutinised and that you look at the essential will want to study for a Specialist Practitioner
skills and desirable skills that are required for the qualification. The importance of having a personal
position that you are applying for. When you compile development plan was discussed and it was stressed
your CV ensure that it meets the criteria in the job that preparation in the form of CV writing, interview
description. Be as succinct as possible when you skills and application processes were important when
answer questions on the application form and do not applying for any new role in the community setting.
add unnecessary information that has no bearing on
the job application. Further Web Resources
• www.adne.co.uk
This website, www.monster.co.uk, will give you a lot • www.nhscareers.uk
of valuable information regarding the format of CV • www.jobs.nhs.uk
writing and the way of using specific words that will • www.changemodel.nhs.uk
enhance your CV. If you are invited for an interview • www.kingsfund.org.uk
it is a good idea to have a practice interview with • www.cno.dh.gov.uk
someone who has an understanding of the role • www.nmc.uk.org
you are applying for. Make sure you are up to date • www.rcn.org.uk
with government and Department of Health policies • www.careers.guardian.co.uk
that potentially will impact on your practice. Be • www.businessballs.com
enthusiastic and remember to let the interview panel
know what specific skills you will be bringing to the
role. If you are asked to give a presentation it is likely
Evaluation
We would be grateful if you would complete a short
that you will have ten minutes to present. Prepare
evaluation on this resource. To take part, please go to
your Power Point slides. Keep these to a minimum
https://www.surveymonkey.com/r/9DKX86N.Thank
(not more than 10 slides) and only write headers or
you.
bullet points so that you can talk around the slides.
Remember to speak slowly and articulate your words.
It is also a good idea to bring your portfolio of personal Acknowledgements
development which will demonstrate how you have Authors: Agnes Fanning and Zoe Berry
been updating yourself and what you have learnt
from the updates. See https://nationalcareersservice. Thank you to the following who reviewed the
direct.gv.uk/advice/getajob/interviews content of the resource during its development:
Should you be unsuccessful at interview it is always Heather Armstrong
a good idea to ask for feedback from the panel – this Jennifer Aston
will help you when you apply for further jobs. Tina Bishop
Debbie Brown
Reflection Jan Gower
Now that you have completed this on line Sue Halliwell
resource, what do you plan to do? Has working through Ruth Wright
the various chapters assisted you in challenging your

Transition To General Practice Nursing (Inglés) Autor Agnes Fanning y Zoe Berry

Uploaded by

Copyright:

Available Formats

Transition To General Practice Nursing (Inglés) Autor Agnes Fanning y Zoe Berry

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Transition To General Practice Nursing (Inglés) Autor Agnes Fanning y Zoe Berry

Uploaded by

Copyright:

Available Formats

Transition to

Section C - The future -

• Provide you with a brief overview of the history of General Practice

Following the formation of the NHS in 1948, General Practitioners were

The public attitude towards GPNs may reflect traditional attitudes

In addition to their role in the management of Role of general practice nurse

referral. • Business acumen

Figure 1. Created by Sharon Aldridge-

Different roles in the community

The multi-disciplinary team

General Practitioners (GPs) - provide a complete spectrum of

District Nurses - are qualified and registered nurses who undertake

Health Visitors- also known as a Specialist Community Public Health

School Nurses - also known as a Specialist Community Public Health

Learning Disability Nurses - provide specialist

‘Transition to General Practice Nursing’ - Chapter 1 - p4

In some instances a SWOT analysis is a good way to establish insight

Diagnostic self-assessed identification of leaning needs for

Example of a completed SWOT

‘Patient contact - in our practice we do get to know

‘Being able to use all of my nurse skills to deal with

‘Helping patients achieve their goals. Optimising care

This Chapter has looked at the history of

General Practice Nursing in the UK and some

of the public attitudes towards community nurses.

‘Transition to General Practice Nursing’ - Chapter 1 - p6

Section C - The future -

The aim of this Chapter is to:

This is a crucial area of support, as the first year in practice is often a

The RCN have developed guidance on clinical supervision:

Introduction of the Reflective Journal

• up-to-date practice and professional development

‘Transition to General Practice Nursing’ - Chapter 2 - p4

• Description: First you describe what happened in an event or

• Feelings: Then you identify your responses to the experience, for

• Analysis: The ‘Feelings’ and ‘Evaluation’ steps help you to make

• Conclusions: With all this information you are now in a position to

Here is a practice example of reflection using Gibbs:

• Description: First you describe what happened in an event or

• Feelings: Then you identify your responses to the experience, for

• Evaluation: You can also identify what was good

• Conclusions: With all this information you are Johari Window

1. Known self - these are things that you know

2. Hidden self - these are things that you know

‘Transition to General Practice Nursing’ - Chapter 2 - p6

By considering the four domains it should help you to identify what

Here is the same practice example of reflection using Johari Window:

How to write reflectively

Tips on how to maximise learning time: General Practice Nurses’ Quotes

about some changes that Mary could consider such

After this experience I plan to structure my

‘Transition to General Practice Nursing’ - Chapter 2 - p8

Section C - The future -

The aim of this Chapter is to:

Whilst working in general practice there is legislation that exists to

Some Legislation that protects working in general practice:

For specific guidance on safety in General Practice follow this link:

The five ‘Sign up to Safety’ pledges

Here is the link for further information: