Transformation Partners in Health and Care > News > The evolution of a practice: 25 years as a practice nurse

The evolution of a practice: 25 years as a practice nurse

Ruth Amartey, Advanced Nurse Practitioner, Allum Medical Centre, Leytonstone, London and the clinical lead for Waltham Forest Community Education Provider Network (CEPN)

“Whatever we face and whatever we do, one thing will never change and that is the desire and passion to put our patients first, to excel at the work we do and how we communicate in order to deliver care with courage, compassion, commitment and competence”.

We have a practice population of over 15,500 with 3 partners, 3 salaried GP’s, 1 Registrar, 1 Physician Associate, 1 Advanced Nurse Practitioner, 2 part-time General Practice Nurses (GPNs), and a Health Care Assistant. Being a training practice, we host; Medical students in years 1, 3, 4 and 5, Student nurses, Nursing associates, Paramedics and new to general practice Nurses on a year’s placement. Practices will vary in their structure and this allows us to deliver an exemplary service which we stand for and expect.

A GPN’s role varies according to training and levels of experience. For example, new GPNs will begin with delivering general treatment room services such as immunisations, wound care, NHS health checks, while more advanced GPNs will work autonomously delivering a variety of specialist care around long term conditions (LTC) such as diabetes, asthma and patient triage. This allows the practice to manage the growing number of people with LTC and tackle the increasing demands from patients, alongside the pressures attached to hospital avoidance strategies.

Patient quote: “The visits I’ve found them to be informal and friendly, easy to setup. I have appreciated a continuity and accessibility to the same practice nurse which helps to develop a practice relationship which motivates you to try harder, a knowledgeable friend rather than a knowledgeable person. It’s a subtle but real difference.”

When I first began at this practice it had a population of about 10,000 patients, which has now grown considerably to the current total of 15,500. With gentrification of the area, our patient’s expectations, demands and needs are a lot different than they were 25 years ago.

A good example of this would be the management of LTC. Patients are much more aware of their own health with increased technology and access to information. We have moved away from the more medical model of care to one of enabling and empowering patients to manage and take responsibility for their own health.

We offer what is now considered basic requirements for access; online and telephone appointments, electronic ordering of prescriptions and access to view parts of their health care records. I also communicate with patients via e-mail providing them with test results and advice which saves both time and money, and reduces the pressure on our appointments and telephone services. All these services are in addition to continuing to offer the traditional telephone and walk in appointments.

I remember 15 years ago debating the future of general practice with other nurses and we could see that processes and technology would change, but I never imagined offering all of this online access to our patients, and Telecare/Skype was not heard of. These services were not available and at the time many generations would not have accepted this as a way of life. Online services do not come without challenges and risks; security, training of staff and the now rapidly changing face of technology. It took both the staff and patient’s time to adjust to these services and understand that they save one of the most valued commodities of our generation, and that is time.

Today our practice is delivering the service that is required with all its challenges. We endeavour to listen to our patient’s expectations, needs and suggestions and try to accommodate their needs where possible.

GP quote: “Ruth is an invaluable member of the clinical and managerial team at the Allum. The patients give excellent feedback about her regarding both her knowledge and attitude towards patient care”.

My experience as a nurse over the last 25 years has taught me that the wheels keep turning whoever is in power; that we often revisit previous formats in another guise, for example cottage hospitals closed and poly centres emerged years later providing similar services. Patients expectations have changed, there is much more demand for the immediate, fuelled by advancing technology and a society that expects to get what it wants here and now. We can never stop learning and as professionals, if we stand still, we are actually going backwards; we have to move forward in our expectations, our learning and education, time stands still for none of us. We have to grab opportunities with both hands otherwise we can miss out and regret what is passed. I would never have imagined the level of autonomy that I have now, that I would be an independent nurse prescriber with the level of responsibility that this holds. Whatever we face and whatever we do, one thing will never change for nurses, and that is; the desire and passion to put our patients first, to excel at the work we do, how we communicate and deliver care with courage, compassion, commitment and competence.

Our Transforming Primary Care programme is assisting with the delivery of the General Practice Forward View that includes a specific work stream on Workforce including General Practice Nurses and Health Care Assistants. Please contact us if you have stories to share and want to get involved