A new programme is helping clinical commissioning groups to better organise training for practice nurses, write Sheila Hardy and Anna Moore

Nurse and patient

Staff nurse Charlene Betts

Charlene Betts

Clinical commissioning groups need to organise training programmes in mental health and wellbeing for practice nurses.

The Department of Health and the Joint Commissioning Panel for Mental Health agree that early intervention and prevention to help tackle the underlying causes of mental ill health needs to be carried out in primary care. It is therefore important that healthcare professionals working in this area are knowledgeable about mental health.

Practice nurses make up a large part of the primary care workforce and have increasing responsibility to make decisions about patient care. The Royal College of General Practitioners has set out the required competencies for practice nurses, a large number of which include mental health and wellbeing.

However, in an analysis of practice nurse responsibility and training needs carried out in 2008, mental health was not specified as a responsibility of any of the respondents, and only six practice nurses cited mental health as a training need.

Two focus groups

A survey published in January also asked practice nurses about mental health and wellbeing. This survey was advertised nationally and there were 390 responses from practice nurses. GPs and CCG leads were also asked to complete a three question survey but sadly as only 14 of each group responded their responses cannot be seen as representative of their professional colleagues.

Two focus groups were also carried out to find out the views of practice nurses without providing the prompts and picking lists that are present in the survey. The results from these groups are described separately in a full survey report.

Key survey findings

  • Practice nurses are getting older. Most are over 40-years-old (89.5 per cent) with 56.9 per cent being over 50.
  • The number of GPs working in each practice has increased since 2008 but the number of practice nurses has remained the same.
  • 42 per cent of practice nurses have had no training in the area at all.
  • 82 per cent of practice nurses have responsibilities for aspects of mental health where they have not had training.
  • 98 per cent of practice nurses identified at least one area of the training that they would like to attend.
  • Most practice nurses (89 per cent) think their current role includes some aspect of caring for people with common mental health problems.
  • The majority of practice nurses (95 per cent) ask patients about behaviour that increases the risk of cardiovascular disease and offer advice.
  • Only 23 per cent of practice nurses presently carry out the annual dementia review and 42 per cent carry out the annual physical health check for people with severe mental illness.
  • A third of practice nurses would struggle to attend a course because gaining agreement from employers is difficult.
  • Practice nurse prefer face to face training in a classroom environment to training in the workplace. E-learning is preferred as part of a package of learning including face to face rather than in isolation.
  • None of the CCG lead respondents believed that their organisations were in the process of arranging a programme of training for practice nurses.

The practice nurses identified a number of mental health areas that they are responsible for in their day to day practice.

To adhere to their code of conduct nurses have a duty to make a holistic and systematic assessment of physical, emotional, psychological, cultural, spiritual and social needs. It is encouraging then that the practice nurses taking part in this survey and focus groups see looking after the patients’ mental health and wellbeing as part of their role.

‘More than a quarter of practice nurses did not think that the relevant courses were available’

However, it is disturbing to note that 82 per cent of practice nurses have responsibilities for aspects of mental health and wellbeing where they have not had training and a little less than half have had no training in this area at all.

Appropriate training

The code of conduct stresses that if a nurse feels they are being asked to undertake work that they have not been properly trained to do, they should not carry out that work until they receive appropriate training and proper supervision.

It would appear from the survey that the lack of training is not due to the practice nurses’ motivation to attend such courses as 98 per cent of them identified at least one area of mental health and wellbeing training that they would like to attend.

However, a number of barriers have been identified; a third of practice nurses would struggle to attend a course because gaining agreement from employers is difficult to obtain, and a further third said their employers would not pay.

‘Practice nurses need to have access to appropriate education that is fit for purpose’

More than a quarter of practice nurses did not think that the relevant courses were available. E-learning has become a popular mode of delivery in primary care because it is inexpensive and means nurses do not have to leave their practice to complete it. However, the practice nurses simply value this as an adjunct to attending a training course rather than as a standalone method. 

Additionally, the survey showed that more than 46 per cent of the GP respondents would not provide time for the practice nurse to complete an e-learning module. It was disappointing to find that none of the CCG leads were aware of any current programmes to educate practice nurses. They have a responsibility to educate GPs about the importance of employing primary care workers who are skilled, able and supported to provide mental health services.

In order to ensure quality of service and safeguard high standards of care, practice nurses need to have access to appropriate education that is fit for purpose and will promote their understanding of mental health and wellbeing. The views of the practice nurses in this survey have been used to help shape such a programme of learning.

A system of education

The local education training board Health Education North Central and East London, the academic health science network (UCL Partners), mental health trust Barnet, Enfield and Haringey Mental Health Trust, foundation trusts Camden and Islington, East London and North East London, and GP practices have worked together to develop a practical and sustainable system of education.

It was delivered to practice nurses by mental health nurses from the four trusts who were trained to become nurse educators. These nurse educators support each other through action learning sets to create a system of support and ongoing learning.

Participants learn about the various aspects of mental health and wellbeing that they will meet in primary care and how they as practice nurses should look after patients.

‘There is an urgent need for appropriate training to be made nationally available’

Creating a sustainable solution to capability and capacity building for mental health in primary care is a core objective for the programme. To meet this need a community of practice for the community and practice nurses interested in continuing their development in mental health is currently being set up with the support of the innovation unit.

This community of practice will form the foundation of the anticipated second phase of work. This is to develop a reciprocal programme in which practice nurses will deliver training to mental health nurses in order to develop their competencies in physical healthcare.

Despite the current emphasis on parity of esteem between physical and mental health, practice nurses are frequently required to deal with psychiatric disorders that they have not been educated to manage. There is an urgent need for appropriate training to be made nationally available.

The programme described is a practical, sustainable solution which could be duplicated in other areas through collaborative working between local education and training boards, local trusts and CCGs.

Dr Sheila Hardy is an education fellow and Dr Anna Moore is director at the Integrated Mental Health Programme, UCL Partners

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