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Nurses should benefit from a structure for role and career development in primary care and general practice
An education and career framework for general practice nursing has been launched by NHS England and Improvement, Health Education England (HEE) and Skills for Health. The framework has been heralded as a turning point for the sector – but what does it cover and aim to achieve?
Nursing Management. 29, 5, 12-13. doi: 10.7748/nm.29.5.12.s5
Published: 06 October 2022
The 52-page Primary Care and General Practice Nursing Career and Core Capabilities Framework was commissioned as part of the general practice nursing ten point plan outlined in 2017.
It was led by a steering group, including representatives from the national bodies that have published it along with experts from a range of groups, such as the RCN and the Queen’s Nursing Institute (QNI).
In the foreword to the framework, chief nursing officer for England Ruth May says general practice and primary care is having to continually evolve to meet the increasing and more complex needs of the population.
Nurses have spearheaded this, she says, transforming ways of working. To reflect that, she says the framework ‘offers the opportunity for nurses at all levels to develop and evidence their knowledge and skills as well as providing a structure for career and role development within primary care’.
The framework has two parts: a career framework setting out the different career levels in the field and a description of the capabilities expected at each level. It also sets out the training and qualifications nurses need for each stage of their career, but does not set out expected levels of pay or terms and conditions of each role.
The framework sets out six career levels:
» Support worker.
» Nursing associate/assistant practitioner.
» Registered nurse.
» Registered nurse enhanced level.
» Registered nurse advanced level.
» Registered nurse consultant level.
This does not mean there are only six roles in the field – there are multiple jobs at each level and may be several ‘job steps’ at each stage. For example, the enhanced level incorporates senior practice nurses, nurse practitioners and nurse managers. In addition, because the career framework focuses on levels of practice, not defining roles, some jobs could cut across more than one of the levels. Nurses may be working in a role that includes a broad range of general practice (GP) nursing activities, such as immunisations, dressings and health promotion, but may also provide specialist support to patients with diabetes, which means the role could overlap the registered nurse and enhanced levels.
As well as career levels, the framework provides indicative training and qualification requirements to work at each level. Some of the requirements are obvious. Care certificates and clinical healthcare support qualifications will be needed for the support worker level, while registration as a nursing associate and an appropriate foundation degree will be required for the nursing associate and assistant practitioner levels.
The framework also indicates what training is required for senior posts in the field, from nurse prescribing qualifications at an enhanced level to a master’s degree in advanced clinical practice and a specialist practice qualification (SPQ) in GP nursing. The QNI has been working with the Nursing and Midwifery Council to have an SPQ in GP nursing qualification recognised and is hoping it will lead to a specialist register being created for those working at an advanced level in this field.
QNI chief executive Crystal Oldman says she is delighted by the framework. ‘It clearly demonstrates a structured career progression and the incrementally greater level of capability and experience required at different points. This is good for the future of GP nursing.’
‘The framework ‘offers the opportunity for nurses at all levels to develop and evidence their knowledge and skills’
Ruth May, chief nursing officer for England
The second part of the framework covers the capabilities – defined as skills, knowledge and behaviours – expected at each level. They are broken down into four domains:
1. Personalised collaborative working and health promotion.
2. Assessment, investigations and diagnosis.
3. Condition management and treatment.
4. Leadership, management, education and research.
In the domains, 14 capabilities are defined across three tiers, depending on level of practice.
» Tier one is the capabilities that require a general understanding of primary care or general practice nursing. All those working in the field, from support worker up, will be expected to meet them.
» Tier two covers capabilities that enable more independent working and care provision and a degree of critical analysis. Nurses working at registered nurse and enhanced level will be expected to be at this tier.
» Tier three capabilities will be expected for staff working autonomously and independently, leading practice and operating at the cutting edge of innovation. Nurses working at advanced and consultant level will be expected to be at this tier.
One of the prime motivations for commissioning the framework was to set out a clear vision for GP and primary care nursing. Unlike their hospital peers, there had been little definition to date of what roles there are in this field and the skills and knowledge needed to achieve them.
HEE and NHS England and Improvement suggest nurses should use the framework to plan their careers and push for training. There is also the hope that it can be used to attract nurses into the field. NHS England and Improvement deputy chief nursing officer Hilary Garratt believes it will help promote working in general practice and primary care as a career option by highlighting the range of opportunities available.
Six career levels: support worker, nursing associate/assistant practitioner, registered nurse, enhanced level, advanced level and consultant level
Four domains encompassing 14 capabilities setting out the skills, knowledge and behaviours required
» Domain A: Personalised collaborative working and health promotion
» Domain B: Assessment, investigations and diagnosis
» Domain C: Condition management and treatment
» Domain D: Leadership and management and education and research
Three tiers set out in detail what is expected across each of the 14 capabilities, with each tier covering two career levels
Source: NHS England and Improvement, Health Education England and Skills for Health (2022)
The framework is not just for nurses. Commissioners, employers and education providers can all use it. It sets out ‘clear expectations’ about what staff need to do and the minimum standards for clinical employment, which should be used by integrated care systems, primary care networks and strategic workforce groups. It will enable employers and managers to demonstrate that staff meet the core skills expected, underpin continuing professional development and used in appraisals.
Education and training providers can also use the framework to inform the design of curricula, and delivery of education and training. Association of Advanced Practice Educators chair Kathy Haigh says it provides ‘important clarity’ about what trainers should focus on when they develop their programmes.
This is an abridged version of an article at rcni.com/general-practice-framework
NHS England (2017) General Practice– Developing Confidence, Capability and Capacity: General Practice Nursing Ten Point Plan. tinyurl.com/NHSE-general-practice
NHS, Health Education England and Skills for Health (2022) Primary Care and General Practice Nursing Career and Core Capabilities Framework. tinyurl.com/NHSHEESFH-framework