Much has been said about the incredible efforts of health and social care staff during the pandemic. So it is very odd that one group who have played a key role in rolling out one of our main defences against COVID-19 – the vaccine programme – should feel largely invisible.
And yet they do. They are nurses like me who work in general practice. So what have we done and why do our efforts appear to have gone largely unnoticed?
We have led on both infection control within our services and the largest vaccination programme in history.
We have provided leadership and training to colleagues with limited knowledge around immunisations and have supported patients to consent to and have their COVID-19 vaccination.
This has often involved working long hours, including unpaid in our own time, to support the vaccination clinics and catch up on the now-lengthy backlogs.
We have ensured that the childhood immunisation programme has continued along with screening programmes such as cervical cytology and supporting patients to maintain their chronic diseases, to name just a few.
Similarly, it is essential to keep vaccination rates high to ensure that diseases such as measles and whooping cough do not start to reappear in our population and we play a key role in that too.
‘It's no surprise that many of my colleagues tell me they feel undervalued and invisible.’
This has not been an easy task during the pandemic, especially when we were asking mothers to bring their children to the surgery to be immunised, an environment that many thought was unsafe. So we spent a lot of time making sure that our surgeries were COVID-19 safe and reassuring the parents that they were not putting themselves or their children at risk by visiting them.
Another key area has been cervical cytology. As health professionals we knew that late presentations of cancer would be an issue as we came out of the pandemic and one way to help this was to keep our cervical cytology rates high. Pre-pandemic cervical cytology rates have been dropping year on year so we knew that this had to be a priority during the pandemic.
We have also played a key role in the diagnosis, treatment and monitoring of patients with chronic diseases such as diabetes, asthma and chronic obstructive pulmonary disease.
During the pandemic we had to keep in contact with these patients to ensure that they were monitoring and treating their disease effectively, seeing them face to face when we had to, but balancing this against the fact that many were extremely vulnerable or scared to come out of their homes.
We know our practice population, who the vulnerable patients are, such as the refugee and migrant communities, those who are homeless and vulnerably housed, traveller communities and people with learning difficulties, and have a relationship of trust with them.
Like many areas of health and social care, we're seeing unprecedented demand in an already-stretched system.
Given this and the other circumstances we find ourselves working in, including acute workforce shortages and poor pay, it's no surprise that many of my colleagues tell me they feel undervalued and invisible.
Pay is a key issue. General practice nurses are not paid on NHS terms and conditions and often have only statutory sick pay (including for COVID-19), statutory maternity pay, and no release or funding to accessing training, education and development.
We are autonomous practitioners who work as part of a practice team, yet the ways of working and the GP contract do not recognise us for the specialist generalists we are.
Years of under-funding and poor pay, terms and conditions mean that a system that was already under strain is now in crisis with not enough skilled nurses and many additional roles resulting in dilution of the GPN role.
Demand far exceeds supply and that means patients' needs can no longer be met with staffing levels at the level they are.
We are key to the reduction of referrals into secondary care and play a fundamental role in health promotion and prevention, but without enough of us unnecessary hospital admissions are inevitable.
The role of the nurse in general practice is essential to the provision of safe and effective care, yet given all of the above it's obvious why we feel undervalued and ignored.