Health Education Yorkshire and the Humber (HEYH) won the Workforce award at the 2014 Health Service Journal (HSJ) Awards at Grosvenor House Hotel, London on 19th November.
The Workforce award, sponsored by NHS Professionals, was presented to HEYH for their student nurse training scheme in general practice. The Advanced Training Practice Scheme (ATPS), developed and managed by HEYH, was implemented five years ago to try and produce a model that would promote the entry of nurses into general practice. We spoke to Dr Peter Lane, Clinical Lead and Barnsley GP who works alongside Christine Peake, Scheme Lead, HEYH, to find out more about the great work they have been doing and what their plans for the future are.
Hi Peter, congratulations on your award! How did it feel to win the Workforce category?
It was absolutely fabulous! We are extremely motivated and are now delivering a sustainable solution to easing the workforce pressures on general practice. Gaining this sort of endorsement is great because it helps us to achieve more engagement in the scheme. I want to say a big thank you to everybody at HEYH for all their hard work over the last few years and, in particular, to Christine Peake for managing the development of the model and building the network across the different organisations, but especially for getting the universities on board. Our success is down to teamwork.
What is the ATPS?
The ATPS provides student nurses with accredited, high quality, substantive 6-14 week placements attached to practice nurse teams covering years one, two and three of their
training. We now have eight educational practices that we call hubs, which give the ATPS footprint across the whole of the Yorkshire and Humber region. The hubs have the responsibility of promoting the programme, recruiting local practices and then supporting them to adopt student nurse training as a normal part of their job. Over 130 practices across the region are taking on student nurses across six different universities. This year we’re anticipating that approximately 200 nurses will have had GP placements through the scheme. We’re aiming to increase this to 400 over the next 18 months.
When was the ATPS implemented?
It started about five years ago when a HEYH think-tank recognised that the strain on the general practice workforce was heading for crisis. Initially, it was just a pilot to scope what sort of educational innovation could have a positive effect. Now, it’s evolved into a regionwide, value for money, sustainable model with robust outcomes and national interest. What we call – “from idea to industrialisation to normalisation!”
Why did HEYH implement this model?
When you look at GP numbers and the recruitment/retention figures along with rising demand, it is clear that there is a looming workforce crisis in general practice. We simply have too many GPs retiring and not enough wanting to start a career. The same is happening with practice nurses: many of the most experienced nurses who deliver the more complex services are nearing retirement. This situation is compounded by ever-rising demands and expectations of what we do in general practice as well as the increasing elderly population with multiple chronic diseases. We therefore had to address succession planning. One way we can positively support general practice is by increasing the number of nurse entrants into practice nursing.
What opportunities can students gain through the ATPS?
The programme is very vocational; students learn appropriate skills as well as observing and participating in patient contact. General practice is a great place to learn as the students get close one-on-one supervision from nurse mentors, which is often not possible in a hospital setting. They get a lot of individual guidance and tailored support, which means they are integrated very quickly into the practice nurse team. They gain a much better understanding of the patient journey and working alongside the 6Cs ensures that they are delivering a high standard of care. They also work with pharmacists and other individuals in the healthcare team, giving them exposure to all areas of primary care. Due to this bespoke training, the number of students being employed by GPs is increasing. We’ve even got a Facebook page where student nurses are able to find all the available vacancies in practices. GPs are now happy to employ nurses directly after their qualification which is a change in perception and attitude we are really proud of.
What response have you had from universities?
Universities are really keen to have more student placements in general practice. Of the 1,700 nurses who qualify across our region per year, almost none of them were receiving significant training in general practice. At the moment, they receive community placements where they might work alongside midwives, health visitors or district nurses, but these tend to be very short placements. We regard the six universities as vital partners in our scheme and meet regularly with them to maximise student flows and discuss curriculum issues and support. A GP practice placement is a minimum of six weeks, often reaching 10 or 12. This is a great opportunity to become part of the team and gain valuable primary care experience.
What feedback have you had from students who have taken part on the scheme?
We have collected a lot of feedback from many of the student nurses that go on the placements saying that it is absolutely fantastic. Our scheme has generated a real culture shift in practice nursing as a career choice; from 30% prior to a GP placement to 88% after a placement considering practice nursing as their first career choice. When we first started, the students thought it was a punishment to go into primary care but by the end of their placement they went back to their nurse colleagues and friends with really positive feedback. And, it’s not just the students who have given positive feedback; the participating practices have all been incredibly supportive of the scheme and are keen to promote it to others.
Are there any particular challenges to the scheme?
Engaging practices. I’m a GP and I know what it’s like, it’s busy and fitting in extra meetings to even consider new programmes is very difficult. A major challenge is getting a narrative to explain that there is a major workforce problem in your area. GPs like to be involved so if they feel like they are part of a solution then they are much more likely to engage with it. We spend a lot of time talking to CCGs and practice groups explaining how we can help with their local workforce issues. Our scheme has a very “ground up” approach and all our hubs have a very good knowledge of the local primary care landscape.
Do you have any future plans for the programme?
Looking ahead, we’re confident that we can roll out the ATPS even more so that it can be adopted elsewhere. We will continue to develop it in our region and are now attracting significant interest from other regions. We contribute to national workforce forums, act as an expert group and are keen to develop practice nurse leadership across our region. We support healthcare assistant growth through the apprenticeship scheme and are currently standardising the preceptorship programme for newly qualified nurses going into practice nurse posts. Ultimately, the vision for nurse education is that all student nurses have the opportunity to take on a substantive placement in general practice. This way, every student nurse would gain a better understanding of primary care and general practice, whether they want to pursue it as a career or not.