Role development in primary care

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 is made up of two parts – first, a career framework that sets out the different career levels in the field and second, the capabilities expected at each level.

It also provides an idea of the training and qualifications nurses need for each stage of their careers, although it does not set out the expected levels of pay or terms and conditions of each role.

Six career levels, with multiple ‘job steps’ at each stage

The Primary Care and General Practice Nursing Career and Core Capabilities Framework sets out six career levels:

The framework is clear that this does not mean there are just six roles in the field – multiple jobs exist at each level so there may be several ‘job steps’ at each stage.

For example, the enhanced level incorporates senior practice nurses, nurse practitioners and nurse managers, and as the career framework focuses on levels of practice as opposed to defining roles, some jobs could cut across more than one of the levels.

For example, 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. They may also be providing specialist support to patients with diabetes, however, which means that the role could overlap with the registered nurse and enhanced levels.

Training and qualification requirements to work at each level

Alongside the 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.

Once past the registered nurse level, the framework provides the clearest indication yet of the training 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 is particularly pleased to see the SPQ in GP nursing mentioned – it has been working with the Nursing and Midwifery Council to have such a qualification recognised and is hoping it will lead to a specialist register being created for those working at an advanced level in this field.

Expert view: framework helps define general practice nursing role

By Heather Randle, RCN professional lead for primary care and framework steering group member:

‘We’ve been waiting for the launch of this excellent piece of work. It is strategic, but it does give some much-needed definition to the role, in particular a career pathway from healthcare assistant to nursing associate and on to registered nurse.

‘Ultimately it should help attract and retain nurses, as long as we can act on it, although we need to do more about how we define the competencies at each level.

‘Nurses should be using it to push for training, but also to recognise their role as leaders.

‘Nurses working in general practice tend not to see themselves as leaders but they definitely are. They lead immunisation programmes, they lead on long-term conditions care – they need to start seeing themselves as an equal partner in general practice care.

‘We need to see change on all levels, not just the clinicians themselves. We need employers and organisations at a national level to take note and look to develop the nursing role. That means improving access to training for nurses working in general practice.

‘Commissioners do have money to provide training, so it is better than it was, but GP nurses are still at a disadvantage compared with their hospital peers.

‘Many have to complete training in their own time – and at times fund it themselves.

‘It’s positive to see things turning a corner but there is still a long way to go.’

Skills, knowledge and behaviours

QNI chief executive Crystal Oldman says she is delighted by the framework. ‘It 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 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:

Within the domains, a total of 14 capabilities are defined in detail across three tiers, depending on the level of practice.

Plan careers and push for training

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.

Framework at a glance: levels, domains, capabilities and tiers

Picture credit: SPL

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

• 1. Communication and consultation skills

• 2. Practising holistically to personalise care and promote health

• 3. Working with colleagues and in teams

• 4. Maintaining an ethical approach and fitness to practise

Domain B: Assessment, investigations and diagnosis

• 5. Information gathering and interpretation

• 6. Clinical examination and procedural skills

• 7. Making a diagnosis

Domain C: Condition management and treatment

• 8. Clinical management

• 9. Managing medical complexity

• 10. Prescribing treatment, administering drugs and pharmacotherapy

Domain D: Leadership and management and education and research

• 11. Leadership, management and organisation

• 12. Education and development

• 13. Research and evidence-based practice

• 14. Strategic management

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)

Clarity on training programmes for nurses

The framework is clear that it is not just for nurses. Commissioners, employers and education providers can all use it. It says 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.

For employers and managers, it will enable them to demonstrate that the staff they employ meet the core skills expected, as well as underpinning the continuing professional development that should be available to their staff. It could also be used as part of appraisal processes.

Association of Advanced Practice Educators chair Kathy Haigh says it provides ‘important clarity’ about what those involved in training should be focusing on when they develop their programmes.

Find out more

NHS England (2017) General Practice – Developing Confidence, Capability and Capacity: General Practice Nursing Ten Point Plan tinyurl.com/10-point-GPN-plan

NHS England and Improvement, HEE and Skills for Health (2022) Primary Care and General Practice Nursing Career and Core Capabilities Framework tinyurl.com/primary-GP-nursing-framework