How to become a GP Practice Nurse today and what I love about it

"It was tough but also very rewarding and I felt I was finally realising my potential."

Nurse Practitioner, Jo Baines, describes her journey into Practice Nursing jobs and illustrates the requirements of today’s GPs.

Topics covered in this article

Introduction

How I started as a General Practice Nurse

How to become a Practice Nurse today

What are the Ideal skills needed in Practice Nursing?

Interview tips for Practice Nurses

What are the different roles in Practice Nursing?

A typical day for a Practice Nurse

What are the challenges within Practice Nursing?

What I love about Practice Nursing

Practice Nursing career prospects

What does the future hold?

Introduction

I became a nurse because after going for various jobs in admin and a bank manager who couldn’t cope with a woman after his job, I felt I had to do something that would both interest and challenge me.

My background was economics, I had been studying abroad and returned to the UK to start a new chapter.

Quite where I wanted to go I had no idea.

I met up with my best friend from school; she was training to be a Pupil Nurse, sounded good so I applied.

When I was accepted, I was told I had signed up for three years not two.

That was 40 years ago.

How I started as a General Practice Nurse

I started in GP practice 10 years later after chatting to a patient who was a Practice Nurse and thinking I’d give it a go.

I realise that that doesn’t sound like I had a very structured career path and you’d be right.

I started in a very small surgery doing everything from practice nursing to dispensing to reception work.

Things were very different then and there wasn’t really a proper career path for Practice Nurses.

If you were lucky you got taken on by a practice who had an experienced nurse able to train you.

I had two excellent mentors who taught me an enormous amount as the role is very different from hospital nursing.

There were some courses available for smear taking, family planning and a few others but most of it was learnt on the job.

Today it is very different. You still learn a lot on the job but there is a lot more structured education available in a whole variety of areas so you can gain qualifications to add to your portfolio.

I started practice nursing in 1990 at a very small, rural surgery where I was a 'Jack of all trades'.

It actually gave me a very good grounding into GP land and how the whole system worked.

As my husband changed jobs so I moved too making sure I collected qualifications along the way such as Family Planning and Diabetes certificates.

I then lived in Germany for a year and on return to the UK started work in a local practice.

I was becoming, not bored exactly, but distinctly unchallenged.

I felt I could do more.

The surgery I was at threw up its hands in horror at a Nurse Prescriber (this was when it was basically paracetamol, dressings and laxatives and not much else) so I had to make some tough choices.

My cost benefit analysis of me taking a more advanced role was rejected so I applied for a Nurse Practitioner role at a surgery much further away.

They were willing to train me and took me on.

My word what a steep learning curve!

All the GPs were very supportive and I had a wonderful mentor.

It was tough but also very rewarding and I felt I was finally realising my potential.

I was one of the first nurses to undertake the Independent Nurse Prescribing course.

This made life so much easier.

No more hanging around outside GP rooms to get scripts signed (well a lot less as the formulary wasn’t very extensive).

Due to an outbreak of stupidity on my part I ended up working almost full time and full-time study for about 9 months.

This was clearly a bonkers thing to do and I wouldn’t recommend it however it did hone my time keeping skills, organisational skills and I knew it was only for a short period of time.

I wouldn’t do it again (well probably…).

The travelling time to this surgery meant a move to one nearer home, sadly and a couple of other moves since for varying personal reasons.

At one surgery I had as a patient my old tutor from my student nursing days, so we are talking around 25 years on!

It was lovely to see them and I think they were pleased with how far I’d come.

How to become a Practice Nurse today

To become a Practice Nurse today you still need a surgery to take you on as a newbie but there is also much more official training available.

Ideally before you work in GP practice you will have at least 2 years post qualification experience under your belt and if some of that is in A+E so much the better.

Most areas have a specialist Practice Nurse course that covers all the main areas such as childhood immunisations, the basics of long term conditions such as asthma, diabetes and COPD, travel immunisations, contraception, wound care and how GP practices work as opposed to hospital.

Jobs now are advertised in local press and on sites like NHS jobs.

Practice Nurses work alongside GPs in a health centre of varying sizes.

The personality of the surgery will differ according to the people who run it, the doctors who work there, the reception team and the patient demographic.

It will also be different according to whether you work in a town or a more rural setting.

As a general rule of thumb, you will be working for a practice that supplies a service to the NHS so yes, the services are NHS but you are not working for the NHS in the same way as you would in hospital.

So, working conditions, pay, uniform policy etc are governed by the surgery and not necessarily the same as the NHS hospital side.

What are the Ideal skills needed in Practice Nursing?

Being able to manage your own workload is absolutely essential

Patients have appointment times and you should be able to keep to time.

Lots of people find this extremely challenging and some aren’t able to do.

It’s very different from the hospital working where things are a bit more flexible.

The patients expect to be seen roughly around their appointment time and it’s up to you to keep to time and complete everything in the allotted appointment.

Times are tailored to what you need to do and extended when you first start but you will find you have to pick up time keeping abilities very quickly.

You need to be confident in one to one consultations

You need to be able to justify your decisions to patients (and their families who come with them) when they question you as to why you are doing something.

Be prepared for anything to come through the door - this is why A+E helps especially if you work in a rural practice and the hospital is some distance away.

Patients will come to you first even if they have been having acute chest pain on the golf course for the last two hours, they will drive 20 minutes to see you rather than call 999 (as more than one person has done that to me).

Empathise but remain detached

You will get to know people intimately and their families over the months and years you work in a practice and you can easily become too involved.

Be a team player/solo worker

Whilst you are part of a team you work on your own so need to be mindful of the different ways this affects you.

Be someone who will always ask questions if you are not sure

On your own and running late it can be very tempting to make a guess.

Not a good idea.

We all to have to ask questions.

Be computer literate

Different surgeries have different systems but the two most common ones are Emis Web and System1.

The surgery will train you on its system but knowing how to use a computer is vital

Interview tips for Practice Nurses

Show them you want the job!

Go for an informal visit.

Have a look around the surgery, meet the team and ask questions.

Make sure your CV is to the point and relevant.

Look at how what you have done already can relate to the job you are applying for.

Transferable skills - make the most of what skills you have already and adapt them to the surgery environment.

Why should the surgery employ you?

Make us want you. You will typically have at least 3 people interviewing you.

A doctor, a nurse and the Practice Manager or HR head.

Don’t be intimidated by this.

What are the different roles in Practice Nursing?

The two main roles are Practice Nurse and Nurse Practitioner but within that is plenty of scope for you to devise your own workload.

As a Practice Nurse you can do mostly Treatment Room work which means dressings, smears, ear washouts, injections, travel, basic contraception.

I enjoy this work and so do many others.

Some of the work like ear washouts overlap with HCA (Health Care Assistant) work.

You can specialise in wound care and this is typically within the leg ulcer world so gaining skills like compression bandaging and doppler examination.

Most surgeries do minor operations and you can assist with this.

Other Practice Nurses will develop specialist interests in long term conditions, mental health, learning disabilities and contraception.

This can mean running specialist clinics and taking responsibility for annual reviews.

Becoming a Nurse Practitioner is now a Masters level degree course and you will work in GP practice having responsibility for your own work load, your own referrals, requesting bloods/x-rays/ECGs/USS and managing patients exactly the same as a Doctor.

Nurse Practitioners can also take responsibility for long term condition patients such as Asthma, COPD and Diabetes and take over their care rather than them seeing the GP.

Some Nurse Practitioners provide a specialist women’s health clinic and fit coils and implants as well as advising on HRT and menopause.

A typical day for a Practice Nurse

Your typical day will vary according to your role.

You will have an appointment list on the computer which is yours and yours alone.

Appointments will typically be 10 mins long but adjusted according to what you will be doing.

As a Nurse Practitioner you usually see patients who need to be seen that day so can be anything from coughs and colds to skin rashes to abdominal pain or cardiac problems.

You have protected time to deal with blood test results, x ray results, letters, emails and other clinical admin.

Some Nurse Practitioners do home visits and some visit nursing homes.

Typical days are hard to determine as the variety is immense.

What are the challenges within Practice Nursing?

The biggest challenge is time pressure and number of patients to be seen.

Extra patients added on to the list are very common.

GPs and other Nurse Practitioners are 99.9% really supportive and it’s rare to find people who won’t support you but it can happen.

Finding time in a busy schedule to debrief is another major challenge.

Being left on your own can challenge people used to having lots of people around in hospital.

Being paid appropriately is another hurdle but be proactive and if you can justify your salary don’t hesitate to ask.

There are frustrations with services being cut to the bone, long waiting lists and things you are powerless to change.

What I love about Practice Nursing

A big plus for me was getting out of uniform!

Being able to see a patient, diagnose and treat and follow them through is a big plus.

I particularly like seeing patients with long term conditions and managing them.

Patients really appreciate your care and you get a lot of positive feedback.

Knowing you’ve made a difference is a lovely feeling.

Practice Nursing career prospects

There is lots of scope for advancement and you can work your way up through being a Treatment Room Nurse to an advanced Nurse Practitioner with much more responsibility.

As a Nurse Practitioner you will likely be a manager of the nursing team giving you the opportunity to develop a management role.

You could potentially be an advanced nurse in a huge health centre and developing practice and making complex clinical decisions for patients.

You can really, with liaison with your practice develop a role that’s tailored exactly to your requirements and what you like doing.

What does the future hold?

Nurse Practitioners are in great demand especially with the shortage of GPs.

A lot of us are retiring and we need more nurses to take our place.

The course is demanding, needs funding and a great deal of support.

Being in a practice can mean that if you are the only Nurse Practitioner you might feel a bit isolated from other nurses.

It can also be a bit chicken and egg situation where people ask for experience but no-one has the availability to train you.

A lot depends on how the political situation pans out.

Without getting too controversial our current government is not supporting the NHS appropriately, services are being cut to the bone and more and more pressure is being put on general practice and we are expected to cope.

Hours can be long and breaks can be short or non-existent.

The job has become increasingly more stressful.

I am coming up to retiring now and pleased I am.

I do fear for the future of the NHS given current political events and I feel it will be very different in as little as 5 years time.

I could say more.

In terms of salary and conditions it is entirely up to you to negotiate.

I have always negotiated my own pay and conditions (I feel successfully).

At interview you have the ideal opportunity to put your case and again at appraisal.

Demonstrate how you have helped the surgery and what you have achieved and you will be rewarded.

It’s a great job and I would rather work in GP land than the hospital.

I’m always happy to have people observe me for a morning or afternoon to get an idea and I have mentored quite a few nurses.

I hope it goes from strength to strength and I wouldn’t want to put anyone off.

Nurses will always be needed but how things will work in the future, even the near future I have grave doubts and I wind down my NHS career with a certain degree of apprehension.