24 Mar Let’s give doctors and nurses equally good training for Primary Care
Multi-disciplinary training for general practice
This week we will be discussing how our hard-pressed NHS can best provide care for the fifteen million people with a Long Term Condition. Dr Diana Hutchinson sees skill mix as the way forward.
Let’s give doctors and nurses equally good training for Primary Care. It’s not fair.
“Here’s a question. Do nurses and doctors receive equally good training to prepare them for general practice?”
One day I met a newly appointed practice nurse, just starting in primary care. She was keen to learn rapidly about long term conditions, but to her dismay, she was unable to find a concise textbook to cover the basics. I started to jot down a few notes… and went on to write a book, with a team of expert nurses.
I have a background as a GP trainer and MRCGP examiner. It struck me that doctors and nurses have markedly different preparation for careers in general practice.
Junior doctors have several years of structured training for general practice, with high levels of support. By contrast, the training for general practice nurses seems to me piecemeal. This can be a particular problem when nurses are expected to monitor long term conditions. Novice practice nurses can struggle to obtain the training they need.
A nurse starting in general practice will surely be offered the chance to go on courses. The employer may say “You could do a course this year and another one next year, when finances permit” but this ad hoc approach is inadequate for a nurse facing day one in general practice. It’s not fair on nurses and it’s not fair for our patients.
Multi-disciplinary training for General Practice
Here is a suggestion. If we want to encourage multi-disciplinary working, let’s beef-up multi-disciplinary training, for all new entrants to primary care.
We already have courses to “train the trainers”, teaching GPs about educational methods. I would like to see experienced general practice nurses more often enrolled on these courses, so that in the future, we can develop high quality, structured training for nurses entering primary care. Then doctors and nurses could be equally well prepared for their careers in general practice.
I would also like to see more co-located training for junior doctors and new practice nurses. For example, a doctor and a nurse who work in the same surgery could have shared tutorials to improve their consultation skills. This would reduce isolation, encourage mutual respect and promote shared values.
The educator could be a doctor or a nurse, depending on the topic of the tutorial. Eventually the Deaneries might relax their requirements that trainers hold the MRCGP qualification, but here I make a radical proposal. I believe it would be beneficial if general practice nurses could become members of the College.
New name – the Royal College of General Practice
I am a huge fan of the RCGP, which has done so much to drive up standards in British general practice. I like to think that one day the Royal College of General Practitioners will become the Royal College of General Practice. As we develop skill mix in our specialty, that would be real progress.
We work as a team in primary care. It is sad to see the gulf between the educational experiences of doctors and nurses as they prepare to enter general practice. The reasons are historic, cultural and probably sexist.
In the UK, there are fifteen million people with at least one long term condition .Over-worked GPs desperately need to delegate work, but that is only appropriate if they can delegate with confidence.
In a well-organised practice, the nurses should be undertaking routine, pro-active review of patients with long term conditions. Practice nurses are often well placed to provide continuity of care. Nurses can offer their patients a wealth of expertise, but only if they have sufficient training in consultation skills, critical reading and the management of specific diseases.
Multi-disciplinary training must surely be the way forward.
Dr Diana Hutchinson was a GP in Coventry until she retired in 2015. Since then, she has been writing a book on Long Term Conditions, with a team of expert nurses. The book is aimed at practice nurses but is also suitable for other health professionals, especially GP registrars. £4 from every sale will go to the charity Médecins sans Frontières (MSF).