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Primary and Community Care Nursing in Wales

Primary care provides the first point of care, day or night, for more than 90% of peoples’ contact with the NHS in Wales. It coordinates care for the individual, providing direct patient care and signposting patients to the wide range of services in the local community to meet their health and wellbeing needs.  In order to deliver the Healthier Wales Plan, we need engage and support collaborative working across all independent contractors, clusters, health boards and wider stake holders. The community nurse role is evolving as the needs of the patients change and the direction of travel of health moves towards the community. Community and Primary Care Nurses are well placed to influence and support patients making healthier lifestyle choices for themselves and their families alongside public health.  (Strategic Programme for Primary Care: A primary care response to A healthier Wales Issue 1: 2019-20)

General Practice Nurse
General Practice Nursing is a rapidly expanding speciality in nursing reflecting the shift in health care delivery from secondary to primary care. Nurses are increasingly being drawn into this field of nursing because of the ability to work with individuals and families and to take on a variety of roles and responsibilities.
General Practice Nurses (GPNs) are directly employed by General Practitioners (GPs) who are subcontracted by each Health Board in Wales to deliver the GMS contract . Nurses provide direct and planned patient care for people of all ages within GP surgeries in a variety of locations. GPNs are an integral part of the health care team which can include health care support workers (HCSWs), directly employed pharmacists and paramedics, advanced nurse practitioners (ANPs) as well as allied health professionals such as district nurses, health visitors physiotherapists and mental health nurses.
GP surgeries vary size and consequently the number of patients registered, the areas they are based (rural/city) and the differing health needs of the population. In larger GP practices, GPNs form part of a large nursing team which may include ANPs, nurse practitioners, nurses with extended skills, treatment room nurses sharing duties and delegating to HCSWs. GPNs also may support training for pharmacists, medical students, GP Registrars and sometimes pre-registration student nurses. GPNs are heavily involved in health promotion, education of patients and management of chronic disease areas, women’s health, deliver adult and childhood immunisations, travel health assessments and immunisation, wound care, cytology, contraception reviews and advice and much more.
The ANP role has proved highly skilled area within general practice seeing patients via triage, in their homes where they will assess and diagnose, admit patients, prescribe, arrange x-rays and investigations, review results and form an integral part of the medical team whilst ensuring they commit to remain on the NMC register. GPNs are in a good position to deliver the future vision of The Healthier Wales plan for Health and Social Care 2018 using Prudent Health Care principles.
How to train as a General Practice Nurse (Nursing in Practice)
The Queen’s Nursing Institute - Transition to General Practice Nursing

QNI Voluntary Standards for New GPNs published May 2020
RCGP General Practice Nurse Competencies 
RCN Wales Primary Care & Community Nursing for a Healthier Wales 
Role Nurse Descriptors RCN Wales 2017
District Nurse
District nurses play a crucial role in the primary healthcare team. They visit people in their own homes or in residential care homes, providing increasingly complex care for patients and supporting family members.
District nurses play a vital role in keeping hospital admissions and readmissions to a minimum. DNs are also responsible for:
  • assessing the healthcare needs of patients and families
  • Supporting complex care
  • Delivering end of life care
Real life stories- District Nurse
Healthcare Support Worker (HCSW)
HCSW work in hospital or community settings, such as GP surgeries, under the guidance of a qualified healthcare professional
HCSWs who are appropriately trained and empowered are an essential member of a diverse primary care team. Their role provides great potential to link health and social care provision and promote a more integrated workforce through joint planning and training with social care services.
The professional resource Immunisation Knowledge and Skills Competence Assessment Tool has recently been updated by the Royal College of Nursing (RCN) and Public Health England (PHE) to support the training and assessment of registered and non - registered healthcare workers who have a role in immunisation [May 2018].
Once immunisation training is completed, as set out by the standards highlighted below, the RCN and PHE strongly recommend that when a practitioner is new to immunisation they need to have a period of supervised practice to allow acquisition of clinical skills and application of knowledge to practice. New immunisers should identify a clinical mentor who can support them to work through the clinical competencies relevant to their working environment. The competences link to the National Minimum Standards and Core Curriculum for Immunisation Training (PHE, 2018) and the National Minimum Standards and Core Curriculum for Immunisation Training of Healthcare Support Workers (PHE, 2015).
Real-life story- Healthcare Support Worker 
Welsh Government and its partners have developed an NHS Wales Skills and Career Development Framework for clinical HSWs and are exploring the potential to extend its scope to non-clinical staff.