The need to attract new staff to general practice, as well as retain existing staff, is a nationwide problem. The Devon general practice nurse (GPN) workforce profile is heavily weighted towards retirement with 62% aged 50 years and above. To help address this, Devon Clinical Commissioning Group (CCG) started a legacy mentor programme. Sarah Hall, Practice Nurse Lead, and Sarah Harris, Primary Care Development Officer, led on this project.
Workforce challenges
A 2021 Local Medical Committee (LMC) survey demonstrated low morale among GPNs, with many planning to leave after the COVID-19 pandemic. GPN vacancies on the LMC website and NHS jobs were also unprecedentedly high due to practices only wanting to recruit experienced practice nurses, which left no option for newly registered nurses other than community or secondary care.
The legacy mentor programme started as part of the Generational Retention Vanguard Programme (GRVP), a 12-month programme to support general practice in Devon to recruit newly registered nurses (within 2 years of registration), which includes a fully funded University of Plymouth Graduate and Post Graduate Certificate in Fundamentals of General Practice Nursing, mentorship with an experienced nurse and additional funding for CPD. Lorraine Beckett, GPN and Lead Educator at Beacon Medical Group said: ‘The GRVP ticked so many boxes. It provided an accredited course and had the bonus of being funded and providing a legacy nurse mentor. This made it an extremely attractive offer to the GP [partners] and reduced pressure on the nursing team.’
Nurses typically find it hard to get a role in general practice when newly qualified. Kirsty, a nurse who took part in the GRVP said: ‘I qualified during the COVID-19 pandemic and trying to get general practice experience was difficult. I applied for lots of jobs and didn't get any. Then this programme gave me a chance [even though] I had no experience.’
Legacy nurse mentor programme
The legacy mentor programme involved newly registered nurses linking up with an experienced nurse as a mentor. Experienced GPNs in the late stage of their career and nearing retirement agreed to mentor in addition to their substantive posts so as not to impact on an already depleted workforce. In total, 10 mentees and mentors were matched by Devon CCG. This was primarily based on location, although they were never from the same practice. The mentors shared their knowledge and experience with the mentee and completed up to 60 hours of mentoring over a 12-month period.
Discussions were goal orientated and worked towards individual and practice objectives. Clinical observation could be used for building confidence, although this was optional and did not include clinical supervision. Historically, nurses new to general practice are mentored ‘in house’ by their peers which has its advantages and disadvantages. Legacy mentors were deliberately independent from the mentee's practice to allow open and honest discussion in conversations.
Flexibility in the programme meant that the mentor/mentee relationship was organic and continually reflected the needs of the mentee over the 12-month period.
‘This programme has retained me. I was thinking about leaving, I was slowing down, and feeling a bit dispirited.’
Outcomes
The GRVP has a 100% retention rate with practices declaring extremely positive outcomes. The programme has also stopped nurses from retiring. Debs Helps a legacy nurse mentor said: ‘This programme has retained me. I was thinking about leaving, I was slowing down, and feeling a bit dispirited. Sarah Hall picked me up, boosted me, and gave me loads of support. I changed my job and then had this opportunity [to legacy mentor]. And actually, it has made me think that perhaps I don't want to retire now.’
The success of the GRVP has resulted in huge changes for general practice nursing in Devon. A new 5-year GPN strategy (2021–26) and Career and Education Pipeline embeds the offer of accredited training and legacy nurse mentorship for both newly registered and new to general practice nurses from September 2022. Peer support plays a vital role in retention and therefore, monthly meetings and WhatsApp groups have been created to regularly communicate with legacy nurse mentors and GPN mentees across Devon. The NHS Devon Primary Care team, University of Plymouth, Devon Training Hub and LMC are collaboratively working to ensure that all nurses who are wanting a career in general practice see it as an option and that GP practices are supported to allow the opportunity.