The Enhanced nurse is the latest role to be included in the additional roles reimbursement scheme (ARRS) and delegates at our sister title Pulse PCN’s Leeds event heard how it would work in practice.
NHS England primary care nursing lead, Louise Brady, highlighted that enhanced nursing is a level of practice, referencing the 2022, NHS England primary care and general practice nurse (GPN) career and core capabilities framework which sets out a career pathway for general practice nurses.
‘There are six levels of practice and enhanced nursing is one of these,’ explained Ms Brady.
‘It’s a level of complexity beyond first registration. It’s experience, clinical acumen, it’s clinical practice. In order for nurses to qualify for the role, they would need to be quite experienced with a postgraduate qualification, module or certificate at level seven.
‘It means that if I’m in clinic on a Wednesday and in front of me is a gentleman with type 2 diabetes, I can assess cardio metabolic, vascular, renal complications, I can manage Mr. Jones as a whole person and his family with his health and social care needs, because that’s what enhanced nursing practice is,’ she said.
In terms of PCNs there are specific areas in the DES that enhanced nurses can look at, such as population health or women’s health.
‘You might look for nurse expertise in population health so they could manage or lead immunisation or vaccination across the PCN. Women’s health is another area because we’ve got a gap in some populations around good care for women, whether that’s menopause or gynaecological.
‘So, you might have a nurse with a family planning or sexual health training qualification at master’s level and you can use their expertise across the PCN.
‘Some nurses have qualifications at master’s level and beyond in long term conditions, such as respiratory, cardiovascular disease, diabetes, so they would be able to manage some of those patients living with these at population level.
‘That’s where we think the enhanced level practice will add the most value,’ she said, giving the example of using enhanced level nurses across road shows aimed at carers in different parts of Yorkshire.
‘We saw 2,310 carers and families across three half days but we didn’t generate a tonne of referrals back to general practice because we had enhanced level nurses who were expert, skilled nurses – primary and community nurses – managing and dealing with stuff on the day. They took the information back to their PCN and practice and added it onto the GP record,’ she said.
Ms Brady confirmed that she wouldn’t want to see GPNs transferred into enhanced nurse roles by PCNs.
‘We don’t want to take established general practice nurses out of their practice. The ARRS is about the additionality principle. We’d be looking for an experienced nurse to manage complexity at an enhanced level of practice across a PCN.
‘We have nurses working in every level across the capabilities framework in general practice already, the majority have got diplomas in diabetes, respiratory and CVD. That doesn’t change, they are a core part of general practice. The additionality role is the level seven and that’s for overall responsibility across PCNs,’ she said.
There is a cap on the number of enhanced nurses – one per PCN or two for large PCNs – so Ms Brady said that there’s not going to be a lot of general practice nurses leaving their practice for this role. She added that although the ARRS scheme will continue, it might look very different in the next 12-18 months under a new Government. ‘We have GPNs that have never been included in ARRS, so we don’t know whether that will change,’ she said, a move that was petitioned for earlier this year.
In terms of PCNs support of nurses Ms Brady said that PCNs need to look at their budgets and make sure nurses are included in PCN development opportunities, whether that’s leadership or leading a piece of work.
‘That money belongs to nurses as much as it does to a GP colleague or allied health professional’, she said.
Ms Brady also highlighted that nursing teams in general practice are delivering 84 million consultations a year and research from Sonnet, commissioned by NHS England, which shows the value and impact of general practice nursing.
Pulse PCN Events will be heading to London, Manchester and Newcastle later in the year. To register for your nearest event, click here.
