Employing a General Practice
Nurse in Greater Manchester
A guide to recruitment, induction and
ongoing development
Draft V4.5 Pilot Version
October 2013
FOR PILOT VIA PRACTICE
NURSE LEADS FOLLOWING
CCG AGREEMENT
1
Employing a General Practice Nurse
in Greater Manchester
A guide to recruitment, Induction and Ongoing
Development
First published:
Updated:
Prepared by the Greater Manchester Area Team Nursing Directorate and Greater
Manchester Practice Nurse Clinical Collaborative
2
Contents
Section 1: Introduction
Section 2: Getting Started – Things to
Consider
Section 3: Advertising and Recruitment
Section 4: Induction
Section 5: Core Competencies
Section 6: Training and Professional
Development
Section 7: : Clinical Supervision
Section 8: Patient Safety and Patient
Experience
Section 9: Useful Websites and Phone
Numbers
References
3
Acknowledgements
This document was developed with guidance from the General Practice Nurses Core Working
Group in Greater Manchester and Donna Davenport, Senior Lecturer (GPN) Manchester
Metropolitan University. The document uses sections and templates taken from the Working In
Partnership Programme (WIPP) 2006 information combined with information from The Royal
College of General Practitioners, Royal College of Nurses; NHS Oldham, NHS Stockport, NHS
Bolton, NHS Manchester and NHS Liverpool. Special thanks to all the Nurses from the Greater
Manchester area who have contributed templates, examples of good practice and advice on the
production of this document.
Purpose of the Document
The aim of this guide is to aid good practice in the recruitment, employment and ongoing
professional development for Practice Nurses in the Greater Manchester area. This document
provides some useful templates and guidance for General Practices in Greater Manchester. This
guide should be used in conjunction with other policies and procedures within the Practice. It is
important to note that any changes in practice may occur sooner than this document be updated,
the document should therefore be used in conjunction with guidance from both the Royal College
of Nursing and Royal College of General Practitioners.
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Section 1: Introduction1
Practice Nursing is a rapidly developing field of nursing, and Practice Nurses are expanding their
scope of practice to accommodate the demands of patients and public for modern primary care
services. Practice Nurses come to their role from a wide variety of backgrounds, often bringing with
them a broad range of transferable clinical skills and knowledge. However, working in general
practice requires both a sound understanding of primary care and some clinical skills ranging from
ear care to triage, which are often not part of nursing roles. Training needs will depend on previous
experience, and to assist with this, Core Competencies offer a practical outline of the practice nursing
role, and covers the minimum skills that a Practice Nurse should have developed following a period of
induction. This will obviously vary depending on previous experience, it is recommended that this
section of the document is used to identify any training needs.
This document sits alongside the recently produced General Practice Nurse Competencies
Framework produced by the RCGP General Practice Foundation General Practice Nurse
Competencies.
http://www.rcgp.org.uk/membership/practice-teams-nurses-and-managers/information-for-practice-teams.aspx
Both the Practice and the Practice Nurse have a duty of care to ensure that the nurse has the
knowledge and skills to carry out their tasks. Nurses are reminded of their Code of Professional
Conduct:
http://www.nmc-uk.org/publications/standards/
The Royal College of GPs advises a set of standards for quality in General Practice Nursing upon
which this document is based.
Nursing Standards
Feb 2012.pdf
It is recommended that Practice Nurses should not undertake some tasks without accredited
training and evidence of competency, these include:







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Cardiovascular Disease
Respiratory Care
Cervical Screening
Diabetes
Triage Nursing – Minor Illness (Nurse offering Minor Illness/Triage Clinics must have
completed the ENB R38 Triage Course for Nurses working in Primary Health Care or
equivalent).
Ear Care
Immunisation/Vaccination
GPN Nursing Induction Pack – NHS Oldham
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Section 2: Getting Started – Things to Consider
Establishing the need for a GPN in the practice
In order to establish the types of nursing role required within the practice, the needs of the practice
population should first be profiled using current QOF data. This will provide a template that will
enable patient needs to be matched with nursing provision. The role and skills of other community
nurses involved with the practice (eg district nurses, school nurses and health visitors) should also
be considered in this profile of needs.
The Workload Capacity Tool that has been developed by Liverpool Primary Care Trust, provides a
useful model for the calculation of practice nursing hours per general practice, based on population
size and patients with a long-term condition, please click here to see how this tool works:
Link 1 - Calculating
Nurse Time.doc
Before Recruiting a GPN
Before recruiting a GPN the needs of the whole practice should be considered and it may be
useful to draw up an organisational chart to clarify the role that each staff member plays in the
practice. This will allow consideration of how much the practice uses the skill mix within the GPN
team. It is also useful to consider succession planning and contingency arrangements for
unanticipated periods of leave e.g. maternity. The table below provides some advice on things to
consider before employing a GPN.
Things to Consider before employing a Practice Nurse (WIPP)
1) Premises - Does the practice have the room to accommodate another member of staff?
What extra resources would be required? If the practice is planning to employ an additional
GPN, would their working hours need to be opposite to existing staff? Would change-over
time be needed? Could GPNs share resources?
2) Practice Structure - How could expanding the nursing team help the practice to achieve its
objectives? Would a GPN with certain skills (or be prepared to help develop these skills)
need to be employed in order to develop enhanced services? If so, what are these skills
and how would they meet the practice’s objectives? Consider the skill mix within the nursing
team – are HCAs employed within the practice? Does the practice need a senior-level GPN
or advanced nurse practitioner? Alternatively, existing staff may welcome the opportunity to
develop their skills to a higher level, and for junior-level staff to be brought into the practice.
Does the practice require specialist staff, that is those specifically trained in respiratory
disease, diabetes etc. The Practice may also wish to consider becoming a training practice
or provide mentorship for other General Practice Nurses.
3) Clarity of role -Prior to writing a job description for a GPN, the perceived benefits for the
practice and for patient care should be listed. Careful planning and consideration at this
point will maximise the benefits of this additional resource, and minimise risk to patients and
the practice.
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Rates of Pay for General Practice Nurses
The RCN advises that all nurses working within general practice should benefit from appropriate pay
terms and conditions. GPs will need to establish how they will reward nursing staff for increasing job
responsibilities and how they will award annual pay uplifts. The varying level of responsibility and skill
should also be reflected in the nurse’s rate of pay.
The RCN advises that pay should increase in annual incremental stages and that pay rates should
be subject to national pay awards in line with NHS colleagues.
http://www.rcn.org.uk/support/pay_and_conditions/outsidenhs/practice_nurses
Rates of Pay for Practice Nurses

Practice nurses at initial level will have no post-basic qualifications relevant to general
practice and will be part of a larger nursing team working under the supervision of an
experienced practice nurse or nurse practitioner. (salary suggestion £21,000 - £28,000)


The majority of practice nurses will be more experienced practice nurses – please refer to
competencies (salary suggestion £25,500- £34,530)
Nurse Advanced profile will apply to some nurse practitioners (Salary suggestion £30,674 £40,558). Primary healthcare nurse consultants employed by the Clinical Commissioning
Groups (CCGs) would be within this level.
Further information around competencies within each area, and professional development can be
found on the NHS Employers Website www.nhsemployers.org.
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Section 3: Advertising and Recruitment
If the practice has the right recruitment procedure in place from the start, a GPN who fits the
needs of the practice and patient population, and who is more likely to commit to the practice long
term, is more likely to be recruited. The longer the GPN stays in post, the easier the day-to-day
running of the practice becomes and the less often the practice will need to recruit. This could
ultimately save the practice time and money.
It is important to ensure that the process of recruitment and selection is transparent, fair and
equitable, and that it can be defended against any claims of discrimination. The recruitment
process should ideally involve a multidisciplinary approach, including a nurse of appropriate level.
To get the process underway, a good place to start is with job analysis, please click the link for the
WIPP Job Analysis Tool.
WIPP Job Analysis
Tool - Link 2.pdf
This provides the basic information needed to compile a job description and should:
-Identify the tasks involved in the job
-Look at how, why and when the tasks are performed
-Identify the main duties and responsibilities of the job
-Consider the physical, social and environmental conditions of the job
It is good practice for the whole team to have the opportunity to contribute to the development of
the role, especially where duties that have previously been undertaken by other team members
are being transferred.
More information on core competencies can be accessed on the RCN website www.rcn.org.uk .
Equal opportunities
A practice should consider the implications of the Equal Opportunities Act (www.eoc.org.uk) when
sending out application forms. No applicant should receive more or less favourable treatment on
the grounds of race, nationality, colour, ethnic or national origin, age, sex, marital status, sexual
orientation, religion, creed or disability.
Good practice is to attach a monitoring form to the application form, which is detached prior to the
short-listing procedure and kept in confidence in a secure place
Job descriptions
A good job description is one that is accurate, concise and reflects the job purpose, role, principle
responsibilities, accountability, communication and working relationships that have been identified
in the job analysis. Since it forms the basis of the whole recruitment process, it is worth spending
time on the job description to prevent possible problems later in the process.
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The Working in Partnership Programme (WIPP) have produced example job descriptions at
varying levels. These could be adapted for the needs of your own practice.
WIPP Job
Descriptions - Link 3.pdf
Basic Checklist for a JD





Identify the tasks involved in the job
Look at how, why and when the tasks are performed
Identify the main duties and responsibilities of the job
Consider the physical, social and environmental conditions of the job
ctice Employers – Unit Two
The Person Specification
A person specification defines a job in human terms. It identifies the kind of person needed to fulfil
the demands of the job by outlining the characteristics and attributes considered essential or
desirable in the ideal candidate.
While the job description describes the job itself, the person specification broadens the picture to
match the likely candidate with the demands of the job. It should show the minimum requirements
needed to perform the job successfully.
It is important that Practices consider which attributes are desirable or highly desirable and which
are essential to the performance of the role. The more flexible the person specification, the more
flexible the later stages of negotiation about the post can be. Current registration with the NMC
should be listed as an essential attribute in the person specification, it is worth noting that this will
incorporate other factors embraced within the NMC Code of Professional Conduct 2008, for
example, it provides assurance of attributes such as professional conduct, confidentiality,
acknowledgement of working only within own levels of competence, and so on. This means that
these factors do not also need to be individually listed under personal attributes.
The Seven Point Plan
To help identify the basic requirements, various organisations and authors have proposed list
of points against which the demands of the job and the attributes of the candidate can be
measured. One of the best know is the seven point plan (Rodgers)
1)
2)
3)
4)
5)
6)
7)
Physical Make-up
Attainments
General Intelligence
Special Aptitudes
Interests
Disposition
Circumstances
General Practice Employers – Unit Two
For an example of a General Practice Nurse Person Specification please click here
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WIPP GPN Person
Spec - Link 4.pdf
Application form
The application form allows the Practice to gather the same information about every candidate,
making comparisons easier, while giving the applicant the opportunity to outline the particular skills
they could bring to the post. However, many nurses will also send in copies of their curriculum
vitae, which provides an opportunity to review their presentation skills and often offers a wider
view of their employment history.
An example of a GPN Application form can be found here
WIPP GPN
Application Form - Link 5.pdf
Advertising the post
Good employment practice is to advertise all vacancies and this can be done in a number of ways.
Prospective employees should be encouraged to apply and Practices should welcome their
interest through the whole process.
It is good practice to arrange the date for interview before the advert is placed and this can then be
included within the advertisement.
An example of a job advert template can be found by clicking the link below:
Link 6 Job Advert
Master.doc
An example of an encouraging starting statement can be found by clicking the link below:
Link 7 - GPN
Advert.doc
The selection process
It is good practice to include whoever may be working closely with the GPN (once appointed) in
both the short-listing and interviewing process. This might be the practice manager for the nonclinical duties and the senior practice nurse for clinical matters. In addition, the practice may want
to consider whether or not to include a patient representative in the selection process. This variety
of expertise and appropriate professional input will help the practice to make a better-informed
decision, especially around the quality of the responses made by the candidate to the questions
asked.
For practices that do not already employ a GPN, this support could come from within the CCG, for
example, using the GPN lead or equivalent, or involving a GPN from a neighbouring practice.
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The job advert should be eye-catching and aimed at procuring a limited number of suitable
candidates. The more information provided in the advertisement, the more likely it is to attract only
those suitable for the role. Providing contact numbers for an informal, pre-selection chat is often
helpful to both parties so that the job can be discussed in more detail.
Ways to advertise
 Most posts are advertised via NHS Jobs http://www.jobs.nhs.uk/
 Local newspapers – this is often the most effective way of reaching the local population; however, it
can be costly.
 National nursing press – this will reach the widest audience, but can be very costly and may attract
applicants from other parts of the country.
 CCG websites or vacancy bulletins.
 The internet – various job sites and local internet
 Via the Practice Nurse Lead
Short-listing
Using the criteria developed in the person specification, job applications are reviewed for those
that meet the essential and desirable criteria. For a tool to assist with short-listing please click
here:
WIPP Shortlisting Link 8.pdf
NMC registration
NMC Registration can be checked via the NMC free registration-confirmation service at www.nmcuk.org/aDefault.aspx.
Nurses should renew their NMC registration every year, and are required to have demonstrated a 1
yearly achievement of minimal CPD requirements and a declaration of good health and character. It is
vital to check NMC registration for GPNs on a yearly basis at annual appraisal. The attached link is a
letter from the NMC for General Practice which outlines their responsibilities:
NMC checks for
employers.pdf
If nurses do not renew their registration, they are not eligible to practice. It is important to point out that
locum nurses are subject to the same checks required for permanent nursing staff. It is vital this is
checked before any GPN is employed to ensure patient safety.
Enhanced CRB Check
An enhanced CRB check should be undertaken in addition to a check of NMC registration. Further
information is available at www.crb.gov.uk, once this check is confirmed a start date can be agreed.
Interviewing
The make-up of the interview panel is an important consideration – both patient and
multidisciplinary input into this stage of the procedure could prove to be very beneficial. It will
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enable the quality of the answers to be assessed against nursing competences and practice.
There should be a minimum of two people on the interview panel to ensure consistency and
fairness. This will also help protect the practice if there is a later complaint. It may be useful to
include another GPN on the panel, but it is inappropriate to use a peer of the same level. See the
link below for tips and hints on preparing and conducting interviews.
WIPP Interviewing
Guidance Link 9.pdf
Offer of employment
After all the interviews have been completed and a final decision has been reached by the panel
on the suitable candidate, both the successful and unsuccessful candidates should be notified. A
written job offer should not be made to the successful candidate until satisfactory references have
been received, or the job offer should be subject to satisfactory references and a criminal record
bureau check. Once these checks have been confirmed, a starting date can be agreed.
Stockport CCG have produced a useful checklist to assist Practice Managers with recruitment of
GPNs, please click the link below:
Check List to Assist
Practice Managers with Recruitment of Practice Nurses.doc
Contract of employment
The contract of employment starts as soon as an offer of employment is accepted. Employers are
legally obliged to provide every employee with a written statement of their terms and conditions of
employment. This should be in place no later than 2 months from the start date and must include
any terms and conditions agreed informally at the interview. It is prudent to include a probationary
period (eg 3 – 6 months) as this will allow for easy discontinuation of employment if either party is
dissatisfied. Although contracts can be drawn up by the practice, the content of a contractual
agreement should be reviewed by an expert in employment law for the protection of both parties.
See the link below for a template for a contract of employment.
WIPP GPN Contract
Example - Link 10.pdf
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Employers’ responsibilities
The following list provides some necessary standards for employment of staff and can serve as
a checklist for General Practice:
1) Maintaining personnel records for all employed GPNs – a GPN has the right to see their
own individual records on request
2) ensuring an agreed disciplinary/grievance procedure is in place that adheres to the
ACAS Code of Practice (www.acas.org.uk)
3) providing all staff with a written procedures manual covering employment policies – this
will include policies on equal opportunities, bullying and harassment, maternity leave
and sickness absence informing GPNs of their right to join the NHS superannuation
scheme – the practice employer is obligated to contribute towards this scheme
4) checking that staff NMC registration is updated every year
5) offering a degree of flexibility in working hours to cope with unexpected family issues
6) providing a safe and comfortable working environment
7) providing terms and conditions of employment that reflect the principles outlined in AfC
(if adopted)
8) ensuring all GPNs have access to professional nursing leadership
9) providing all GPNs with personal development plans for review at annual appraisal
10) enabling GPNs to both maintain a portfolio of learning, as required by the NMC, and to
demonstrate achievement of the minimum standard of 5 days’ study every 3 years in
order to re-register with the NMC every year
11) providing GPNs with access to mandatory training updates on a regular basis
12) providing a formal period of induction with a named member of staff taking responsibility
for this role ensuring that locum GPNs have the same professional checks as
permanent GPNs
13) providing IT access for GPNs during all clinical consultations; within the practice, GPNs
should also have access to e-mail (via their own e-mail address), the internet, Intranet
and NHSnet resources
14) ensuring that GPs familiarise themselves with the NMC Code of Professional Conduct –
in delegating duties to GPNs, they must be sure of their competence
15) To ensure that the General Practice Nurse has access to clinical supervision
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Section 4: Induction
All GPNs should be given an induction to the Practice. This is an important step in the process of
being integrated into the team and the GPN’s ongoing professional development. An induction will
involve meeting employees within the Practice, especially those the GPN will work closely with.
First Day Preparations
1) Does everyone know someone new is starting?
2) Who will greet the new starter and show them round the premises?
3) Who will be the named coordinator of the induction programme? This
could be the practice manager for the non-clinical items and the nurse
for clinical competencies
4) Who will be their buddy or mentor?
5) Will someone take them to lunch on their first day
6) Where can they put their personal belongings?
7) Has a uniform and identity badge been ordered?
8) Have registered patients been informed that a GPN will be starting at
the practice e.g. via the noticeboard, website or newsletter
Working in Partnership Programme (WIPP)
Before the GPN is able to fully take on their role in the practice they must provide evidence of
competence so this is a key component of the induction programme. Consideration should be
given to who is best placed to assess this competence i.e. a senior clinician for clinical
competence. The next section provides further information around levels of competence.
When putting together an induction programme, the Practice should consider priorities and goals
for the first day, the first week and the first month. A personal record should also be kept by the
GPN for his/her personal development file and as a reference for the future.
Oldham Practice Nurse Lead has produced a useful checklist for Induction, please click the
attached link for the template:
Link 11 -Oldham
Induction Checklist.doc
At Induction the GPN should be shown where the Practice Protocols for the Practice are stored
and be asked to familiarise themselves with these.
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Section 5: Core Competencies
The Nursing and Midwifery Council (NMC, 2008) Code of Professional Conduct stresses that
nurses:
- Must be aware of their levels of competence.
- Must always work within their own competence levels in order to maintain professional standards
and ensure patient safety.
- Are accountable for their actions as well as decisions.
Competencies in general practice can be quite different from other areas of practice and an
assessment needs to be carried out in order to identify areas requiring further training allowing a
nurse to work competently and safely. The attached induction checklist is a good example of a
self-assessment for GPNs to complete when they start at a practice, this should also be reviewed
during the GPNs ongoing professional development, please click on the link below:
GPN Core
Competencies Self Assessment - Link 13.doc
The RCGP General Practice Foundation has recently produced a framework for General Practice
Nurse Competencies which is a vital resource for the Practice Nurse and their Practice in ensuring
their competence in their role, please click on the link below:
http://www.rcgp.org.uk/membership/practice-teams-nurses-and-managers/information-for-practice-teams.aspx
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Section 6: Training and Professional Development
This section links very closely to the above section on core competencies and the induction
period. A survey of General Practice nurses by WIPP (Snapshot Survey May 2008) showed that
some nurses do not have access to appropriate education or professional development which is
vital. The standards below show what should be in place in General Practice for General Practice
Nurses.
Training and Education (WIPP)
 Complete an in-house induction programme for the first two weeks with an
identified member of staff responsible for this (please see section on induction)
 Complete appropriate CPD based on identified needs at PDR e.g. Foundation
Programme, CHSP GPN degree etc
 Have access to an identified mentor; a more senior practice nurse to give them
support in their new role. This is known as Preceptorship, please see the attached
preceptorship guidance provided by NHS OIdham:
Preceptorship - Link
15.doc

Compile a PDP within which any difficulties have agreed goals and action plans. NHS
Oldham have provided an example of a Professional Development Plan (PDP) which can
be used as a template:
PN PDP- blank form
gp employed - Link 16.doc

Meet with the CCG General Practice Nurse Lead or Professional Development Lead to
discuss training needs, access to training and funding
Complete training courses and relevant CPD to the level of the job they are employed to

do
 Receive annual mandatory training (e.g. anaphylaxis, BLS, infection control)
 Receive appropriate training for any new or expanded roles
Professional development support
 Regularly attend practice team meetings with GPs
 Have a source of professional advice and support available
 Belong to a professional organisation or union
 Be supported to work within their scope of competence
 Have access to regular, formal clinical supervision
 Belong to a local practice nurse forum/ group
Quality
 The GPN should highlight any competency issues to their employer
 Have their competence in a new role assessed by a qualified assessor
 Support the update of protocols based on the latest national guidance
 Maintain a professional portfolio in line with NMC/PREP
 Engage in peer review
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
Assist in practice Quality Team and Clinical Governance requirements
17
NHS Stockport have produced a very useful summary table* of training required, please see
below:


(M) = mandatory training requirement
(S) = statutory training requirement
Training Criteria
Frequency
Fire Safety (S)
Annual
Health and Safety Awareness (S)
Annual
Risk (S)
Annual
Basic Life Support – adult and
child (including recognition and
treatment of anaphylaxis) (M)
Safeguarding Children – Basic
Awareness (M)
Safeguarding Children Update
(M)
Infection Prevention and Control
(M)
Annual
Once only
Annual
3 yearly
Safeguarding Adults (M)
Every 3 years after initial attendance
Cervical Screening (M)
Initial training and an update every 3 years
Immunisation and VaccinationInitial training and an NHS Stockport update every 3 years
Child, Adult and Foreign Travel.
(minimum)
Mentorship (New NMC
Annual Update
requirement 2007) (M)
* Please note this is a summary table and maybe subject to local arrangements. For all competencies
required for the Practice Nurse please refer to section 6 of this document
It is vital the Practice Nurse keeps up to date with national requirements for immunisations
and screening; the table below provides a list of weblinks where the relevant information can
be accessed:
Weblink
Immunisations and Screening – Useful Weblinks
Information
Health Protection Academy
Immunisation training resources for healthcare professionals
www.hpa.org.uk
Vaccination and immunisation for communicable diseases,
including specific recommendations for the use of
vaccines/algorithms
Access to travel immunisation information for health
professionals and public
on-line updated version of Immunisation against Infectious
Disease-“the Green Book” containing chapters on all the
routine vaccinations in the UK and the diseases they
prevent.Also includes useful info re Patient Group Directions
Details of the cancer screening programme inc training
requirements,competency assessment for practice nurses
www.nathnac.org.uk
https://www.gov.uk/government/organisations/
public-health-england/series/immunisationagainst-infectious-disease-the-green-book
http://www.cancerscreening.nhs.uk/cervical/publicati
ons/index.html
Cytology Competency Assessment Documents
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The training grid below shows preparation and support advised for the roles in General
Practice Nursing
New GPN
Experienced
GPN
Specialist
Practice Nurse
Advanced Nurse
Practitioner
Foundation practice nurse
course with practice
assessment for competence
Diploma (Level 5) or Degree
(level 6) courses on aspects
of care e.g. asthma,
diabetes, wound care etc
BSc Specialist Practice and
post graduated diploma in
specialist area. Regular
study days to update
knowledge
MSc Advanced Practice,
Nurse Practitioner Course,
nurse prescribing
qualification.
Access to mentor, practice nurse and
clinical supervisor
Access to regular formal clinical
supervision and professional advice and
support from the CCG and/or
professional organisation
http://www2.mmu.ac.uk/
www.rcn.org.uk/__data/assets/pdf_file/0003/146
478/003207.pdf
Appropriate mentorship and
leadership training should
also be sought.
The RCN provides additional information around professional development and career
progression for General Practice Nurses. Please visit www.rcn.org.uk
Funding for Continuing Professional Development
CPD-Apply is an electronic application and monitoring system tool which is available to all North
West placement provider organisations and Universities, who have access to all data concerning
their own learners only. GP Practice employees and non-NHS placement providers can access
CPD modules using CPD-Apply:
http://nw.hee.nhs.uk/our-work/continuing-professional-development/
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Section 7: Clinical Supervision
It is vital the Practice ensures the Practice Nurse has access to appropriate clinical
supervision in order to ensure quality and safety for patients. It complements but
does not take the place of, formal programmes of education at “pre” and “post”
registration level. The practice of clinical supervision involves the supervisor
applying knowledge and experience to assist colleagues to develop their practice,
knowledge and values. It is vital in enabling practice nurses to establish, maintain
and improve standards and promote innovation in clinical practice.
What is Clinical Supervision?
Clinical supervision is “a formal process of professional support and learning which
enables individual practitioners to develop knowledge and competence, assume
responsibility for their own practice and enhance consumer protection and safety of
care in complex clinical situations” (DH 1993)
The provision of Clinical Supervision links to the CQC – Essential Standards of
Quality and Safety particularly outcomes 12-14
http://www.cqc.org.uk/search/apachesolr_search/essential%20standards%20of%20quality
Similarly the National Health and Safety Litigation Authority (NHSLA) Risk
Management Standards 2013-14 can be a useful tool for Practices to ensure that
access to clinical supervision is in line with current guidance.
http://www.nhsla.com/Pages/Home.aspx
The framework of Clinical Supervision recommended by Winstanley (2000)
recommends a group approach to clinical supervision. It is advised that whenever
possible registered staff should be facilitated to attend in protected time within
existing working hours.
Process & Core Requirements for Clinical Supervision
The following have been identified as essential components for any Clinical
Supervision scheme regardless of the implemented model/s.
1) Access awareness sessions for Clinical Supervision
The awareness session seeks to clarify the purpose of Clinical Supervision and the
benefits, and to clearly disentangle Clinical Supervision from other forms of
supervision such as managerial and educational. The principle is reinforced that
Clinical Supervision is for practitioners and is practiced by practitioners.
2) Access to Group Clinical Supervision
Practice Nurses should have a choice of their Clinical Supervisor wherever possible.
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An up-to-date availability list should be kept allowing the supervisee to choose.
3) Access training to become a supervisor
The role of the clinical supervisor is central to the provision of high quality care. It is
recommended that only staff who have attended either an in-house SupervisorTraining Course, or equivalent, should be kept on a supervisor register, as
competency standards will have been set within the training programme. This will
provide consistency of supervisory practice within the Organisation.
To support the Supervisors in maintaining and developing their skills, it is essential
that they have access to update sessions provided by their organisation
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Section 8: Patient Safety and Patient Experience
As more complex care is delivered closer to home, and as patients move through primary,
secondary and social care sectors, the potential for patient safety problems inevitably
increases2
The National Patient Safety Agency has produced a seven step guide to ensuring safety in
General Practice which is summarised below.
STEP 1: BUILD A SAFETY CULTURE



Carry out an audit to assess your teams’ safety culture
Highlight successes and achievements in improving safety and be open and honest when things go
wrong
Apply the same level of rigour to all aspects of safety including incident reporting and
investigation, complaints, health and safety, staff protection, Significant Event Audit (SEA), and
clinical quality assurance
STEP 2: LEAD AND SUPPORT YOUR PRACTICE TEAM



Talk about the importance of patient safety and demonstrate you are trying to improve it by
including an annual patient safety summary in your Practice Report or your Practice Quality Report
Include patient safety in in-house training, including the use of improvement methods, and ask for
it to be part of continuing education outside of the practice.
Promote safety in team meetings by discussing safety issues and making it a standing agenda item
STEP 3: INTEGRATE YOUR RISK MANAGEMENT ACTIVITY



Regularly review patient records (e.g. using casenote review tools) so that areas of common harm
such asdelayed or missed diagnoses/treatment can be identified.
Keep a good SEA record that can be used for the General Medical Services (GMS) contract,clinical
governance, appraisals and revalidation.
Involve wider primary healthcare team members in improving patient safety and use information
from as many sources as possible to measure and understand safety issues in the practice
STEP 4: PROMOTE REPORTING



Share patient safety incidents and SEAs with the National Reporting and Learning Service (NRLS) so
that learning can be disseminated nationally.
Record events, risks and changes, and include them in your annual practice report.
Cascade safety incidents and lessons learned to all your staff and other practices through your
Clinical Commissioning Group or Local Area Team.
2
Seven Steps to Patient Safety in General Practice, National Patient Safety Agency June 2009
www.npsa.nhs.uk
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STEP 5: INVOLVE AND COMMUNICATE WITH PATIENTS AND THE PUBLIC



Seek patient views, especially on what can be done to improve patient safety, and use
complaints as a vital part of modern responsive practice.
Encourage feedback using patient surveys and websites such as NHS choices.
Involve your practice population via patient groups, open meetings, or by inviting patient
representatives to patient safety meetings.
STEP 6: LEARN AND SHARE SAFETY LESSONS



Hold regular SEA meetings, reflecting on the quality of your care, patient safety and lessons for
the future.
Make the discussion of significant events and the national analyses of patterns of risk
everybody’s business, including the wider primary healthcare team as appropriate, and act on
your findings.
Share experiences with other practices by making your patient safety lessons widely available.
STEP 7: IMPLEMENT SOLUTIONS TO PREVENT HARM



Ensure that agreed actions to improve safety are documented, actioned and reviewed, and
agree who should take responsibility for this.
Use technology, where appropriate, to reduce risk to patients.
Involve both patients and staff, as they can be key to ensuring proposed changes are the right
ones.
A key area for learning and quality is step 5 of the above guide which involves
communicating with patients and public. A GPN should seek out feedback from
his/her patients on their performance, this can then be used to inform areas for
professional development and increase the quality of service.
An example of a survey which can be provided to patients is the Nurses
Interpersonal Skills Questionnaire, please click the link below:
Nurses Interpersonal
Skills Questionnaire.doc
Other ways of gaining feedback is through paper or online surveys, and encouraging
patients and carers to visit websites which encourage patient feedback. The National
Association for Patient Participation website provides lists of questions compiled
from existing validated surveys. Practices may find it useful to draw on these
questions when creating a survey.
http://www.napp.org.uk/index.html
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This area of work is growing and for further advice and support in monitoring patient
safety and patient experience please contact NHS England, Greater Manchester
Area Team.
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Section 9: Useful Websites
Website Link
Information
www.cqc.org.uk
Care Quality Commission – Essential Standards
www.sign.ac.uk/
www.dh.gov.uk/
www.bmj.com/
www.bnf.org.uk
www.thecochranelibrary.com
www.mhra.gov.uk
www.nice.org.uk
www.nurse-prescriber.co.uk/
Scottish Intercollegiate Guidelines Network
Department of Health
British Medical Journal
British National Formulary
The Cochrane Library
Medicine and Healthcare Products Regulatory Agency
National Institute of Clinical Excellence
A free online educational service and information resource
devoted to all nurse prescribers
Immunisation information for health professionals and
immunisation practitioners
National Electronic Library for Health
Breast, Cervical, Bowel & Prostrate Screening
Travel Health
Journal of Evidence Based Practice
The Green Book
http://www.immunisation.dh.gov.uk/
www.nelh.nhs.uk/
www.cancerscreening.nhs.uk/)
www.who.int/ith/
www.ebn.bmj.com
http://immunisation.dh.gov.uk/category/t
he-green-book/
www.nmc-uk.org/
www.rcn.org.uk/
www.diabetes.org.uk/
www.stroke.org.uk/
www.nos.org.uk/
www.guideline.gov/ (Clinical guidelines)
www.childrenfirst.nhs.uk/
http://primaryhealthcare.rcnpublishing.co
.uk
www.dh.gov.uk/health/2011/07/ltc-elearning/
www.travax.nhs.uk
www.nathnac.org
www.independentnurse.co.uk/
www.nursinginpractice.com
www.hpa.org.uk
www.dh.gov.uk/health/2011/07/ltc-elearning/
Nursing & Midwifery Council
Royal College of Nurses
Patient and professional information & good for leaflets
Stroke – patient/carer information
Osteoporosis
Clinical guidelines
Advice for children
Journal for primary care)
Learning for health and social care)
Register on line for Travel advice through Travax)
Travel advice
Professional resource for primary care nurses
Nursing in Practice online magazine
Health Protection Academy- vaccination and immunisation and
communicable diseased
Learning for health and social care)
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References
The code: standards of conduct, performance and ethics for nurses and
midwives www.nmc-uk.org
The General Practice Nursing Career Framework Working in Partnership
Programme www.rcn.org.k
RCGP General Practice Foundation General Practice Nurse Competencies
http://www.rcgp.org.uk/membership/practice-teams-nurses-and-managers/information-for-practice-teams.aspx
NHS Employers www.nhs.employers.org.uk
Equal Opportunities Act www.eoc.org.uk
Criminal Records Bureau www.crb.gov.uk
Manchester Metropolitan University www2.mmu.ac.uk
Health Education England www.hee.nhs.uk
Care Quality Commission (2010) Essential Standards of Quality and Safety www.cqc.org.uk
NHS Litigation Authority www.nhsla.com
Seven steps to Patient Safety in General Practice , National Patient Safety Agency June 2009
www.npsa.org.uk
Winstanley J (2000) Clinical Supervision: Development of an Evaluation Instrument. School of Nursing, Midwifery
and Health Visiting, University of Manchester, Manchester
National Association for Patient Participation www.napp.org.uk
NHS England www.england.nhs.uk
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]
Review date: 1 April 2014
Contact: Nursing Directorate, Greater Manchester Area Team, Piccadilly Place 3,
Manchester, M1 3BN
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