Practice nursing: going from strength to strength

Recent developments in GP nursing practice and education outline the remaining challenges in general practice

Dr Brendan O'Shea, GP and Lecturer, Department of Public Health and Primary Care TCD, Dublin and Dr Roisin Doogue, Associate Professor, General Practice, University of Limerick

April 3, 2024

Similar articles
  • At present there are over 2,300 general practice nurses (GPNs) working in general practice in the Republic of Ireland. In September 2022, the ICGP stated that this needed to increase to 4,000 full-time equivalents in the intermediate term, if the planned and burgeoning workload envisioned for general practice in the Sláintecare era was to be met. 

    The aim of doubling the capacity of the GPN workforce has been driven by a range of new GP nurse tasks and services which has since been rapidly growing. This is in addition to task-shifting with respect to jobs and services previously carried out predominantly by GPs, but now increasingly and successfully carried out by growing numbers of GPNs and advanced nurse practitioners in general practice (See also Forum March 2024 cover story: ‘How nurse practitioners are enhancing GP care’).

    Much of this growth in the GP nurse role has happened from the ground up, and on the basis of microdevelopments instituted at the practice level. But as the Sláintecare era progresses, this process of transformation will also be driven increasingly from top-down directives, from the Department of Health, the HSE, and with essential input from the IMO, the ICGP and increasingly the Irish GP Nurses Educational Association (IGPNEA) and GP Advanced Nurse Practitioners Group.

    The past

    Back in the 1980s GPNs were far and few between, their numbers slowly growing despite official neglect, and initially with practically no educational or financial support. Contemporaneous with what was known as ‘The GP Wives Association’ (GPWA), the IGPNEA was established in 1989 for the educational support of general practice nurses. After a bright brief existence, the GPWA passed gently into history, but only after very usefully highlighting and addressing the need for GP pensions, GP sick leave, holiday leave supported by payment, and improved availability of GP locums. 

    The IGPNEA however, has since its inception shown form and endurance. General practice in Ireland owes much to the IGPNEA, which for over 30 years has delivered a steady stream of professionally based peer-delivered education tailored for GPNs, enabling their networking, and running its own excellent journal. 

    The IGPNEA has been endorsed by a steady and consistent growth in membership. Since 2017, a working group has been in operation between the ICGP and IGPNEA, which has included several colleagues, and/but particularly the ICGP medical directors, the IGPNEA chairs, members of the Education Committees of both, and the ICGP CEO. 

    Two key tasks agreed at the outset included the development of a core curriculum for a postgraduate diploma course for GPNs, as a key part of education, and increasing the volume of educational opportunity for all GPNs, thus addressing the needs of general practices. 

    This would be capable of meeting the educational needs of nurses who are either considering general practice nursing as a career, or who are mid-career in general practice nursing. It would also include nursing colleagues with established expertise in general practice nursing who wish to develop stronger practice, either as GP advanced nurse practitioners, or as GPNs, with depth in academic practice, linked with schools of nursing/midwifery or university departments of general practice.  

    The present

    Now, there are arguably six streams of GPN education available, few of which are financially supported adequately, formally or consistently recognised, but are nonetheless growing irrepressibly (see bullet points below). In 2023, a first and fully funded intake for the UCD Postgraduate Diploma in Primary Care Nursing commenced, which reflects closely the curriculum, with 30 places (fully taken) of the 60 places reserved for GPNs. This occurred as a collaboration particularly driven by UCD School of Nursing, UCD Department of General Practice, with ICGP/IGPNEA input in the Course Management Committee and Sláintecare funding.

    Six streams of GP nursing education – which of these are relevant for your practice?

    • Academic Track (PG diploma, leading to MSc/doctoral research)

    • IGPNEA Principles in GP Nursing Course (12-module course suitable for new entrants/mid career GPNs)

    • Micro-credentialling (acquiring skills following short courses). Varies depending on regional/local considerations

    • Practice-based learning (varies depending on individual practice needs and interests)

    • IGPNEA/ICGP collaborative activities (from 2017, GPNs are increasingly enabled to attend ICGP activities) 

    • GP advanced nurse practitioner credentialling 

    A second intake will commence later this year for what is an in-depth blended learning course, including a mix of synchronous and asynchronous learning online, as well as in- practice and in-person teaching. The ICGP/IGPNEA Working Group is currently represented on the Course Committee.

    Now also in its second year, the IGPNEA Principles in GP Nursing Course is currently run over a 12-14-week period, throughout the year, with a throughput of around 160 candidates per annum and growing. Our experience with micro-credentialling is uniformly positive, with university schools of nursing and departments of general practice keenly interested in GP nursing/primary care nursing in the Sláintecare era. The ICGP/IGPNEA working group has also closely engaged with the Technical University of the Shannon and University of Limerick, finding open doors everywhere. Separately, there is a GP Advanced Nurse Practitioners Group of over 40 GP nursing colleagues who are building collective expertise in a rapidly growing range of topics and conditions within general practice. 

    The future

    From all of the above, you might consider that there are no challenges in all of this but you would only be partly correct. We can understand that progressive and trend-setting practices have been able to support GP nurse education in creative and innovative practice, but for many practices, such progress is far from assured, and certainly neither easy nor always possible. 

    Much of the educational activity outlined in Table 1 still runs as non-commercial and inconsistently recognised strands of learning. There is no uniform career progression (ie. pay increments for additional qualifications) for many GP nurses, and it has been frankly difficult and challenging to secure the consistent constructive interest of key stakeholders to ensure that GP nurses are on a comparative and equal footing with their colleagues employed by the HSE (eg. in the acute hospital sector and in community care). 

    While growing numbers of practices do variably provide pension, sick leave, educational leave and educational support for GPNs, they largely do so at direct cost to the practice, and in a manner which relies more on goodwill than on a secure and properly funded professional process. 

    To achieve the stated objective of 4,000 full-time GPN equivalents working at the top of their skillset will require all of us to remain tightly focused in the intermediate term. There is a sense that the fluidity and innovation which was so evident during the pandemic has already ebbed, and frankly this cannot be allowed to happen, nor can we continue to trade on the professionalism, enthusiasm, goodwill and skills of our GPN colleagues for the necessary development in GPN capacity at practice level. 

    At the ICGP/IGPNEA Educational Working Group, we are collectively of the view that an excellent basis has been established to build critical capacity in GP nursing from an educational perspective, but we are under no illusions regarding the remaining challenges which require to be met, including the full support of the Department of Health, the HSE, the IMO, ICGP, and academic colleagues working in university departments of general practice and schools of nursing throughout Ireland. We all have much to gain in addressing these issues.

    Building this particular capacity from a health system perspective is a classic ‘important/non urgent task,’ which typically are the tasks which are often neglected in average or poorly performing systems. The growing contribution made by GPNs to both general practice and the Irish health system is simply too important to allow this to happen.

    © Medmedia Publications/Forum, Journal of the ICGP 2024