The development of the education and career frameworks for district nursing and general practice nursing is the first attempt to develop a national solution to enable a consistent approach to ensuring the whole district and general practice nursing team are equipped to deliver health outcomes now and in the future.
‘Care in local communities; A new vision and model for district nursing’ (DH, 2013) describes the roles of District Nurses (DNs)in population and caseload management delivering preventative support, care for patients who are unwell, recovering and rehabilitating at home, have Long Term Conditions (LTC), require end of life care and support and care for independence. It also identifies action needed to work with Higher Education Institutions and other education and training providers to ensure the curriculum will equip DNs with the skills and knowledge to enable them to deliver the new service offer. It identi es the need to promote professional development and support joint training between DNs and other members of the community nursing team i.e. Health Care Assistants (HCAs) and Community Staff Nurses, and the need to secure suf cient training commissions to deliver the service offer.
The development of the education and career frameworks for district nursing and general practice nursing is the first attempt to develop a national solution to enable a consistent approach to ensuring the whole district and general practice nursing team are equipped to deliver health outcomes now and in the future. It has also been recognised that while some provider organisations in England value the need for a level 6 professional to lead the community nursing team, they are not all choosing to insist that person is a qualified DN, so a degree of exibility in catering for that is also implicit.
In contrast to the DN role, while General Practice Nurses (GPNs) sometimes work alone in GP practices or in teams that may include HCAs and other specialist nurses, their work is usually delivered in general practice premises. Their role is mainly to contribute to the delivery of the GP contract across the spectrum of provision and the life course of the practice population. This requires a specific skill set necessary to manage uncertainty and risk when supporting people who may have undifferentiated diagnoses. GPNs and their teams also need to have the ability to work within integrated teams to deliver care based on guidelines and protocols e.g. Quality Outcomes Framework (QOF) to enhance the quality of health outcomes, in particular in prevention and supporting those with LTC who need support to self-manage.
The education and career frameworks, while differentiating the two roles within both of these nursing disciplines, supports standardisation and also sets out their comparators and expectations for each level in both skills and educational requirements which will assist with workforce planning and educational commissioning. In short, it will enable HEE’s education commissioners within Local Education and Training Boards (LETBs) to first identify organisational learning needs with providers, then commission education opportunities, enabling practitioners to plan and develop their career, thus assisting employers in conjunction with workforce planners to enable the provision of high-quality care.
The education and career frameworks begin with a description of the key characteristics of district and general practice nursing to enable a clearer understanding of their core and specific roles. This then leads to a specialised stepped education and career illustration based on the NHS Career Framework and Skills for Health Career Framework and indicative academic levels, not Agenda for Change banding as the latter is not within the confines of the Health Education England (HEE) role.
Further to this, each level is supported by a key responsibilities and role description that give examples of how they are implemented into practice which is further supported by level descriptors that state the core values, skills and competency expectations. Along with this, the minimum vocational, professional and academic requirements at all levels are articulated.
For registered nurses, the four pillars of clinical practice described in the Advanced Practice Toolkit (http://www.advancedpractice.scot.nhs.uk) have been used to describe the requirements of each role. These are: Leadership and management; Facilitation of learning; Evidence, research and development; Clinical practice.
Whilst both frameworks outline the specialist knowledge, skills and experience required to deliver district and general practice nursing care across the various levels, there is also recognition of core skills and commonalities which are reflected within both frameworks. Consequently this document gives versatility in terms of the commissioning and development of these roles as either can be generated in isolation of each other or via a hybrid model that combines the two. The frameworks have been developed with the expectation that roles up and including level 5 are fairly similar and more specialisation occurs from level 6.
They have been developed to support the work of practitioners, commissioners, employers educationalists, workforce planners, policy makers, regulators, indemni ers and most of all to enable service users, carers and the public to have a greater understanding of these nursing services.