In July I was honoured to be asked to participate in an NHS Clinical Commissioners (NHSCC) panel for an event on the launch of their report ‘Primary Care Networks – One Year On’ (NHSCC, 2020).
The question posed to me was ‘How important is it to have a range of clinical professionals in the clinical director role?’ This was a fabulous opportunity to speak about the challenges for nurses with ambitions to become primary care network (PCN) clinical directors—a subject that myself and colleagues at the Queen's Nursing Institute (QNI) are frequently asked about by the practice nurses in our QNI networks. The following was my answer:
‘It is vital that we have PCN clinical directors from a wide range of clinical backgrounds, bringing different skills and perspectives to the role. I am a registered nurse, so I am going to say a few words about the potential for nurses to be successful PCN clinical directors. And what PCNs—and our communities—are missing by not taking advantage of their skills.
We have around 1250 PCN clinical directors and less than 20 of these posts are filled by nurses. There are a small number of pharmacists and the vast majority, therefore, are GPs. Nurses make up the second largest group of clinical professionals in general practice after GPs—around 24 000 registered nurses are working in general practice in England. Again, let's remember just 20 of them are clinical directors of PCNs.
For the next 3 minutes, I want to ask you to please stand in the shoes of a general practice nurse.
You have worked in general practice for 25 years. You work in the area you grew up in, you trained in a university nearby and you live in the community you serve.
You have developed your skills and knowledge by undertaking postgraduate programmes, including population health, to become a highly skilled clinical practitioner and an independent prescriber.
Your skills include the teaching and management of the nursing and health care assistant team; you lead on all the population health programmes and manage the group consultations for a number of long-term conditions.
You are an expert clinician in diabetes management and have often presented to general practice nurses in the locality and to the clinical commissioning group (CCG) on the success of your work in relation to improved diabetes control, reduced hospital admissions, as well as the economic benefits of the improvements made.
You also lead on the teaching and learning of all students in the practice, linking with other practice nurses in the locality, the community services provider, local voluntary organisations and the local authority. Your work has resulted in the GP surgeries in the area always recruiting newly qualified nurses to general practice from the local university.
The post of clinical director is advertised and this looks like a fabulous opportunity for you to build on all the skills you have and to take on a leadership role in the PCN. You know you have so much to offer.
But less than 20 nurses are PCN clinical directors in the whole of the country and at least two of those were practice partners before becoming a clinical director.
So where do you go to ask for advice and guidance on applying for the role? Where does PCN clinical director feature as part of the career pathway for a general practice nurse? If you were in a hospital or a community services provider, there is a clear pathway to deputy and then director of nursing, but not in primary care.
Your closest friend who you trained with works in the local hospital and is now a deputy director of nursing. Three years ago she was offered by NHSE/I a fully funded ‘Aspiring Leaders’ programme and she is still supported by the cohort of peers she met in the programme who work across England as directors of nursing.
So, you can see—many nurses in this position, perfectly capable, don't apply for the PCN clinical director role—and we also risk losing them completely to other parts of the system.
Nurses have leadership and management in their DNA—it is part of our training from day one—we are taught these skills in theory and practice as a nursing student. Our postgraduate programmes in general practice nursing build on this, with negotiation and building complex relationships across a wide range of agencies as a core skills. All the skills needed for the PCN clinical director role!
So, there is a huge opportunity to capitalise on the existing skills of senior general practice nurses and to support their development into PCN clinical directors.
But unless we show nurses the way, provide access to the ‘Aspiring Leaders’ programmes, support and build their confidence, help them to articulate their value—we will miss that opportunity to see them flourish and help PCNs succeed—and arguably our communities will be less well served as a result.’