| 27 July 2022
Julia Taylor is an advanced nurse practitioner who has been working in primary care for the last 20+ years.
She is currently GP Programme Training Director for the East Midlands, which sees her lead on learning and development initiatives across the region.
- Primary care is the linchpin of the NHS, it’s where the vast majority of people are seen, looked after and cared for, and it underpins everything else within the health sector. How do you think the pandemic impacted it?
Well, I think the first thing to say is that the pandemic really did turn everything upside down and inside out and changed our ways of working completely, pretty much overnight.
One of the main things it has changed is our increased use of technology.
We’ve got video consultations, telephone & email consultations, as well as face-to-face now.
We’re also better at consulting over the phone since the pandemic, so we’ve become much more proficient in offering more choice to our patients.
A key challenge primary care faces now is keeping up with demand.
There are lots of patients who, for a variety of reasons, kept away during the crisis. That being so, more and more we’re dealing with people who need to be seen and need to be seen quickly.
Nevertheless, I think on the whole primary care responded really well and flexibly, which goes to show the expertise, skill and resilience within primary care.
- What are the challenges for primary care longer term?
Managing demand to ensure better patient outcomes really is key in my view.
In many ways, primary care has become a victim of its own success, insofar as we’ve generally come to assume that our GP will put it right.
As we grow as a nation, that kind of model is no longer sustainable, both from an economic perspective and a population health perspective.
With an ageing population, you also have more people with more complex conditions, lots of multimorbidity.
The primary care workforce is also ageing, making it difficult to bring capacity in line with growing demand.
- How do we best respond to these long-term challenges?
It’s a complex picture.
The problem for primary care is that much of that increased demand lands at their doorstep in the first instance.
Managing that demand is difficult.
Whereas in the past, the GP has been almost the first person that you pick up the phone to, that needs to be shared now because of capacity issues.
Depending on the practice that you work in, you could be looking after 40,000 patients or more. That’s a huge number of patients, and it is likely you will be getting over 3000 calls a day.
That’s a lot of telephone calls to manage, and whilst it’s not always an appointment that patients are after, there’s lots of assisting and signposting going on which takes time.
Finding new ways of working and ensuring patients get the appropriate level of care is crucial.
- So, do you think finding smarter ways of working and managing people’s expectations is key to striking a balance between primary care capacity and demand?
Absolutely. It’s about ensuring patients get the appropriate level of care and have choice.
With an ageing population, we are often trying to manage somebody with multiple problems, on 15-20 different medications within a 10-minute appointment. That really is a tough ask.
On the flipside, you’ve got other people that wake up that morning with a sore throat and think they need to ring you immediately, rather than wait and see if it gets better.
Considering this, patient education is key.
On the one hand, it’s about educating the public about some of the things that can be managed safely over the phone, and the things that need to be seen urgently or routinely.
You will always get patients that want to be seen face to face, that have their own preferences. Likewise, people that prefer to be seen over the phone, sometimes we have a hard job of convincing them that they need to have a face-to-face examination.
Managing that type of demand and trying to support people to look after themselves and make some choices around their own lifestyle and wellbeing and health is a balancing act.
The aim is to shift the power back to patients and the public and give them ownership of their own health.
- How does staffing come into this?
Staffing in primary care is changing and evolving.
After GPs, nurses are the largest staff group in primary care.
In the very beginning, nurses came in to help the doctors with task-orientated stuff such as immunisation. When we look at how that has evolved over the years it’s incredible.
The role of nursing is expanding, particularly as a whole population’s approach to health starts to become more embedded.
A great example of this is one of the practice nurses I met with recently, who set up a drop-in centre to tackle loneliness.
Being lonely and not having contact actually has a very detrimental effect on your physical and mental health, so being able to make positive changes like this within your patient population is vital.
It is also the case that more and more GPs are choosing to have portfolio careers and work part-time, as are other health care practitioners within primary care.
Against this background, primary care nurses look set to play a much greater role in the surgery and out in the community in years to come.
- Speaking of practice nurses, can you tell us more about your recent work with Health Education England and Skills for Health?
The new framework sets out six career levels for nurses within primary care and aims to provide a clear skills structure for staff, from support worker level, right the way up to consultant level practice.
Fundamentally, it allows people to see the opportunities within primary care, by detailing the skills, knowledge and behaviours that nurses in general practice and primary care will need at each of these levels.
This gives people something to aspire to.
Moreover, it will help workforce planners, employers and providers to add capacity and boost recruitment and retention within primary care.
- With recruitment and retention at the heart of this new framework, from a personal perspective, what would you say is the main pull of becoming a practice nurse?
Every day is different – there is scope to work differently as part of a team.
The reason I entered the profession was to be a part of the community space – I wanted to be able to do things in a way I felt worked best for my patient populations.
There’s always been opportunity to tweak or enhance the way I did things, so if you are an innovator, I think it’s a really great place to go and innovate.
To learn more about the revised career framework for general practice nurses click here.
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