In July 2019 when primary care networks (PCNs) were introduced, a conversation took place on Twitter between nurses in primary care and general practice. These conversations centred around general practice nurses' (GPNs') involvement and understanding of the newly launched PCNs. While the majority of GPNs involved in the conversation were not involved in PCNs, a small number of nurses reported that they had become clinical directors of PCNs.
In order to test whether this picture was similar for GPNs in the regions, a series of listening events were conducted by the NHS England and NHS Improvement (NHSE/I) GPN 10 Point plan team, supported by the National Association of Primary Care (NAPC). Three key issues emerged from the events. GPNs:
- Didn't see themselves as leaders
- Didn't always understand why PCNs had been established or how they worked
- Didn't recognise the value of their inherent skills and capability around population health to help deliver local and national strategy.
What is CARE?
CARE (Connected, Authentic, Resilient & Empowered) was developed in order to address these three issues. A practical, person-centred and locally owned change management, leadership and resilience programme, CARE is the product of a partnership between NHSE/I, NAPC, the psychotherapeutic coaching agency ShinyMind, and Bedfordshire, Luton and Milton Keynes (BLMK) integrated care system (ICS). CARE empowers GPNs and other primary care professionals to play a key role in their PCNs, enabling them to shape services based on population health needs and to strengthen their leadership and resilience.
The NAPC had been working in BLMK since 2018 to support delivery of their local strategy and was first commissioned in 2019 by the GPN 10-PP programme team to pilot an approach to align the work of the GPN 10 Point Plan to the NHS Long Term Plan (LTP) and local system strategy in BLMK.
As the COVID-19 pandemic struck in 2020, rather than delay or cancel the initiative, CARE continued to be offered to nurses in primary care using digital and virtual innovation. A pilot programme, designed and delivered in partnership with BLMK system leaders, was so successful in improving participants' resilience, leadership and influencing skills, building confidence and enhancing job satisfaction, that it has since been rolled out to six other systems, supported by national funding from NHSE/I GPN 10 Point Plan. An additional 10 systems are planning to run CARE in 2021/22 with a combination of national and local funding, and a further seven systems have also expressed an interest. So, in less than a year, CARE has already got 24 local systems in England engaged – more than half of the 42 local systems.
CARE is delivered over a period of 6 months to cohorts of up to 25 future primary care nurse leaders. Some of the systems have broadened the offer of the programme to other primary care professionals and nurses in community and care homes and this supports their plans to introduce MDT working and nursing integration. The programme is designed to overcome GPNs' lack of self-belief that they cannot become leaders, fill the gaps in their knowledge and empower them to be agents for transformational local change.
CARE is made up of three key elements:
- Leadership development starting with self – delivered through a series of webinars delivered by ShinyMind to help participants identify what holds them back and give them strategies to break free. Key to this element is the ShinyMind app, a wellbeing and resilience mindset tool, co-designed with NHS staff, which creates active communities of support
- Leadership development through practical projects – equipping participants with the knowledge, skills, and confidence to deliver practical population health improvement projects for and with their PCNs
- Embedding CARE principles/change locally – with consultancy support for local systems on how to tailor CARE inputs, support and messaging to fit local priorities and engage influential health leaders.
Net Promoter Score
The spread of the CARE programme throughout the regions has been captured in a measure that predicts the growth of a business idea known as the ‘Net promotor score’.
NPS rating of 70 or above is rare, however the CARE programme has obtained a NPS of 75 (Figure 1), which suggests that a lot of the participants share their experiences by word of mouth, often through social media such as Twitter, and this often leads to discussions and collaborations in new systems.
Figure 1. ‘Net promotor score’.
Comments from participants about the overall impact of the programme are shown in Figure 2.
Figure 2. Comments from participants about the overall impact of the programme
Conclusion
CARE takes a holistic approach to supporting and developing GPNs in local systems. It aims to put nursing at the centre of primary care transformation by building their leadership capability and understanding/application of population health management. This powerful combination is addressing resilience, population health and leadership development in the round by putting them into a clear and practical context - that of the day-to-day job of a GPN. GPNs feel more empowered, more valued and able to influence their system as a result of CARE and they don't have to work out how to apply resilience training at work, or how to link complex population health management theory/datasets to their everyday jobs. As well as more impactful, a holistic approach is likely to be more cost effective and sustainable in the longer term.
If you want more information aboutv CARE, please email Clare Simpson, Programme Director, NAPC, clare. simpson@napc.co.uk or Karen Storey, Primary Care Nursing Lead, NHSE/Ikaren.storey@nhs.net.