My Journey from Return to Practice to General Practice Nursing

In January 2013, for the first time, my NMC licence to practice as a registered nurse lapsed. Circumstances had made nursing, and shift work in particular, very difficult.

However, during those seven years out of practice I never felt that my nursing career was over and as time went by my wish to return grew stronger and the possibility of doing so more possible. At age 54, with both nursing and life experience, I found myself taking a broader view of what I wanted to achieve both professionally and personally by returning to nursing.

Firstly, there was the need to refresh and update both theoretical and clinical skills, and for that I was grateful for the opportunity to apply to the Return to Practice (RTP) programme. But I also wished to move away from the bedside nursing that had been the core of my prior experience and explore new avenues in primary care where health promotion and disease prevention are at the fore of practice. So, I began to explore the possibility of not just returning to practice, but starting on a new path in General Practice Nursing.

My first enquiry into applying for RTP at one of two local universities was at the beginning of March 2018 but it wasn’t until the following March that I attended my first day on the RTP course. Finding a clinical placement within General Practice had taken time, although I was fortunate to have help from the local Primary Care Learning Environment Lead for Health Education England (HEE), who was instrumental in assisting primary care nursing students secure clinical placements.

After much searching a placement was found in a GP surgery. Not all surgeries choose to be involved in training nurses, be they undergraduate students, newly qualified or returning to practice so I was excited to have the support and interest of a surgery within reasonable access to my home.

HEE explained that taking on nursing students not only offered practice staff the chance to develop teaching and mentoring skills but also gave surgeries the opportunity to provide an ‘extended job interview’ to prospective new staff. The placement enabled me to both meet the clinical requirements of the course and re-register with the NMC. but most importantly gave me a preview into the role of the General Practice Nurse (GPN).

The experience was exciting on many levels; not only being back in uniform and feeling part of a nursing and broader multidisciplinary team but simultaneously being introduced to, and exploring, a completely new specialty. I was renewing and refreshing the fundamental skills and requirements of a registered nurse whilst observing and learning skills that were completely new. On reflection I feel this was not only challenging for me, but also my mentor, especially in comparison to the more typical mentoring of students who were completing their undergraduate studies. However, with the support of my mentor and other staff at the surgery I was not only able to re-establish the core skills and confidence to practice again but also confirmed my wish to continue training and working as a GPN.

Unfortunately, when my placement with the surgery ended, having recently employed an experienced community nurse, a position was not available to me. I suspect that my lack of experience and need for further training were a significant factor when faced with the choice of employing a GPN with prior primary care experience.

It took a few months before the RTP course results were published and my subsequent re-entry onto the NMC register confirmed. During this period, armed with the knowledge that GPNs were increasingly in short supply and specialist training courses were not only available but being promoted and funded by HEE, I distributed a letter and my CV to all GP surgeries within commuting distance of my home. Although many of the practices I contacted responded with interest, they were ‘sorry to inform me that currently no positions were available.’

Eager to practice now that I was re-registered and having somewhat lost confidence in my suitability to pursue general practice nursing, not only as an older nurse recently returned to practice but with limited prior experience, I decided to apply for a staff nurse position on a general medical unit at a local hospital. I also considered following up with the community nursing team I had shadowed as a student, which had suggested I might apply for a position. In hindsight this would have been a valuable experience for an aspiring GPN, but at the time I felt I lacked the experience required to work alone, caring for patients in their home.

Being back on a medical inpatient unit was both exciting and daunting. Many aspects of the work felt familiar, as if I’d never left, but of course much was new and after a short induction period I found myself wishing I were in a student uniform, not that of a qualified staff nurse. The work was challenging, with so much to learn but rewarding too as I quickly retrieved and refreshed skills I had acquired throughout my nursing career.

After five months, just as I was beginning to settle in and progress my responsibilities on the ward, I received a call from a local GP practice inviting me to discuss the possibility of a position as a trainee GPN. Despite the commitment I had made to the hospital, this was the opportunity I had been waiting for and I knew I mustn’t let it pass. To my delight I was offered the position which entailed completing the post-graduate level 6 Foundations in GPN course whilst working alongside a mentor at the practice.

My first day at the practice was at the beginning of March 2020. Two weeks later the country went into its first national lockdown.

It was a strange beginning to a new job and new specialty, but I was made to feel very welcome and supported. The university were forced to defer the Foundations course by four months which gave me a chance to observe, learn and understand the role and feel better prepared to undergo the specific training. I have now been at the practice for 18 months and completed the foundations course in June 21.

It was an intensive period of learning, made more so by the pandemic restrictions, combining working and studying, attending long days of online or virtual training with some welcome face to face sessions where necessary. The course, spanning eight months, required the completion of a substantial portfolio of work incorporating both core and optional skills, many of which were entirely new to me as a registered nurse.

It was a challenge combining the theoretical and academic demands of the university whilst simultaneously acquiring the practical clinical skills at work. However, the course provided a broad overview of the role, incorporating for example, health promotion, working in the primary care team, safeguarding and mental health in primary care and crucially communication and consultation skills. This broader learning, in addition to the specific optional skills training, provided a greater understanding of the role and eased the transition from secondary care nursing. I feel a sense of achievement being part of the practice team, working autonomously and within the wider primary care team, seeing patients of all ages and performing tasks such as cervical cytology, complex wound care and now leading child immunisations.

As I reflect on my journey from return to practice to general practice nursing, I consider what I have learnt along the way. Not just new skills required for the role but the growing importance of primary health care and the essential role that GPNs play. I also consider the time it took from my first enquiry into return to practice to starting work as a GPN. The funded foundations course by HEE made it more likely that a practice, such as the one in which I work, would employ a nurse with no prior experience.

However, I believe a shift is needed in thinking that general practice nursing is for older nurses with prior professional and life experience, but instead that it form an integral part of undergraduate training, offering students greater opportunity for clinical placements. It is well understood that many GPNs are approaching retirement age and training of new staff to replace them is not keeping apace. I firmly believe that general practice should be opening their doors and encouraging students, newly qualified nurses, and those returning to practice, of all ages, gender and experience, to consider primary health care as a specialty career pathway. After all, GPNs care for patients across the whole spectrum of society.

When first qualifying as a registered nurse in 1986, at that time hospital based, what I found most fulfilling was the essential nature of the work. Patients were unwell, they needed care and you were trained to deliver it. In my work as a GPN I have that same feeling, only now the emphasis is keeping people healthy, preventing ill health and helping people to manage, improve and prevent complications from chronic disease.

Primary health care and general practice has changed beyond all recognition in the past seventy years and much of this change would not have been possible without the essential and indispensable role of the GPN and although I’m still a novice and expanding my knowledge and skills every day, I am proud to call myself a GPN.

Imogen Banks
September 2021