A practice nurse e-Appraisal project: Strategy; development; implementation & sustainability

This innovative e-appraisal project commissioned by NHS England (BGSW) introduced new ways of thinking for the development of practice nurses across Bath, Gloucestershire, Swindon & Wiltshire.The success of the project can be seen through the impact it had on some practice nurses working lives and the new skills they have learnt to support themselves and their peers. The project was designed and based on sustainability from the onset to allow its continuation after its completion.Practice nursing in general practice is complex and demands a host of varied advanced clinical and non-clinical skills within autonomous practice. Along with these advanced skills sets there is a need to engage, support and embrace change for practice nursing within the current dynamic changes within primary care. Until recently practice nursing has not been seen as a key nursing career and therefore little support was offered similar to their professional colleagues in secondary care. This position is slowly changing due to student placements and the emphasis on the benefits of working in primary care in response to the numbers of nurses and GPs retiring.This project revealed some of the gaps in both support and development for practice nurses working in isolation from nurses in other settings. Although the project itself focussed on e-appraisals for senior practice nurses, it was clear from the onset that it encompassed wider aspects of practice nursing such as clinical supervision, revalidation, accessing continual professional development, teamwork and embracing new ways of working. Allowing the Practice Nurses the flexibility, time to reflect, and re- focus on issues important to them, it encouraged them to think objectively and more strategically about priorities for them, their team and general practice in its entirety.The project highlighted confusion between appraisal and performance reviews and it became clear that appraisals were not seen as important or recognised as necessary for all practice nurses. The project initially involved a recruitment process, a strategy for training appraisers and a design of reciprocal arrangements across local Practices for when project funding ceased. The main aim was to train sufficient practice nurse appraisers evenly across four geographical counties to enable practice nurses in every Practice to access an appraisal within a reciprocal agreement. The success of this innovative project was due to the commitment of the Practice Nurses who saw opportunities for a robust appraisal system with the added incentive of meeting most of the criteria for revalidation. The inclusion of formalising clinical supervision and CPD was the bonus of this project as it helped to remove isolation in practice and provided opportunities to share good practice and problem-solving in their busy working lives

An evaluation of primary care led dementia diagnostic services in Bristol

© 2014 Dodd et al. Background: Typically people who go to see their GP with a memory problem will be initially assessed and those patients who seem to be at risk will be referred onto a memory clinic. The demographic forces mean that memory services will need to expand to meet demand. An alternative may be to expand the role of primary care in dementia diagnosis and care. The aim of this study was to contrast patient, family member and professional experience of primary and secondary (usual) care led memory services. Methods: A qualitative, participatory study. A topic guide was developed by the peer and professional panels. Data were collected through peer led interviews of people with dementia, their family members and health professionals. Results: Eleven (21%) of the 53 GP practices in Bristol offered primary care led dementia services. Three professional panels were held and were attended by 9 professionals; nine carers but no patients were involved in the three peer panels. These panels identified four main themes: GPS rarely make independent dementia diagnosis; GPS and memory nurses work together; patients and carers generally experience a high quality diagnostic service; an absence of post diagnostic support. Evidence relating to these themes was collected through a total of 46 participants took part; 23 (50%) in primary care and 23 (50%) in the memory service. Conclusions: Patients and carers were generally satisfied with either primary or secondary care led approaches to dementia diagnosis. Their major concern, shared with many health care professionals, was a lack of post diagnostic support