By Gee Harland

Advanced practice nurse and trainee coach, Anna Young, is advocating for primary care nurses’ voices to be heard at policy level and to ensure their ‘uniqueness and importance’ is recognised and valued. She highlights ‘how much poorer primary care and patient health would be without nursing in it’.

Primary care nurses are often seen as approachable which can sometimes mean people do not realise the level of skill and expertise the profession has, says Young, who qualified as a nurse in 2001.

‘Because nurses are seen as approachable, patients will tell us things that they won’t tell other people because we’re seen as one of as one of them,’ she says.

‘That’s our blessing and our curse, because we’re seen as one of them, people don’t realise the high skill that nurses have.

‘We’re trained to work with the whole person. We don’t have a medical model approach, we don’t have a disease focused approach, our training is to look at the bigger picture, to look at the biopsychosocial, to look at the spiritual aspect of the patient, to look at their emotional needs, and to have that understanding of the impact of their society on them too,’ the South Yorkshire non-medical prescribing/independent prescribing development lead for primary care says.

However, despite the uniqueness Young highlights of the role, she fears nurses are being ‘pushed’ out due to issues including funding cuts, lack of leadership structures, and the dilution of nursing roles.

She now hopes to use her seniority to advocate for the next generation of primary care nurses.

‘One of our challenges as nurses is getting better at articulating and this campaign is a fantastic opportunity to do that, articulating our uniqueness, our importance, and how much poorer primary care and patient health would be without nursing in it,’ she says.

Young, who is also an advance practice training programme director for primary care at NHS England’s Regional Faculty of Advancing Practice, started her portfolio carer in emergency admissions before realising she wanted to help stop people attending hospitals ‘inappropriately’ and taking on a preceptorship and moving into community nursing.

After several years, she moved into case management before taking on a practice nursing role where she focused on the four nursing pillars – clinical practice, education, research, and leadership.

When completing her advanced practice qualifications, Young wrote a dissertation on the need for better support and development for non-medical prescribers in primary care, which she worked to embed in practice.

She then collaborated with the Primary Care Workforce and Training Hub (PCWTH), based in Humber and North Yorkshire, to develop policies and tools for non-medical prescribers. Young also spoke at the International Research Conference by Royal College of Nursing (RCN) which she is a professional member of, highlighting the impact of the research in practice.

She is now, in her own time, focusing on advocating for nurses to have a role in local nursing advisory committees and meetings, such as neighbourhood meetings or policy tables hosted by the Department of Health and Social Care (DHSC), so they have a platform to discuss key issues within the industry.

Young added that when NHS England and integrated care boards (ICBs) remove advanced practice leads or nursing strategic leads in ongoing restructures, there is no other layer to hold that voice, governance or safety net in primary care.

Another concern is that other independent professions such as GPs, dentists, optometrists and pharmacists, have funded advisory councils that can pay for admin and space, but nurses do not, she says.

One issue she stresses is that funding structures in primary care networks means new roles are being invested in for tasks already completed by general practice nurses (GPNs).

‘For nurses, it means that other people were coming in and are doing the jobs that historically nurses were doing… nursing is kind of being pushed out,” she says.

She adds there is also a gap in GPN training. ‘What we need is highly experienced nurses and we won’t get that at the moment because that funding is not coming through,’ she says.

‘And the problem nurses have is that we’ve never articulated very well what our unique selling point is, and why it’s so important to have us as nurses in primary care.

‘We haven’t had leadership structures with people above team leads within practices to articulate that at a senior level. We don’t have those layers in which to advocate for nursing and to turn around in these meetings and say, “you need a nurse to do that”.’

She fears this issue will only worsen if leadership structures are not addressed.

‘I think there are a lot of gaps at the moment that are only going to get bigger with the current climate,’ she explains. ‘And I think one of the reasons that those gaps are there is that we haven’t got the roles for senior nurses to be articulating it at policy level, at government level, which is why we’re trying to set up these local nursing advisory committees.

‘Nurses are told, “You’re already spoken for, you’ve got GPs in the room” and that’s not good enough because we’re not GPs, and we’re not GPs helpmates.

‘We are independent practitioners who have our own unique role. Nursing voices must be at that table.’

When asked why nurses may not have spoken up before, Young says that the focus has always been on patients.

She adds: ‘I think nurses historically have said, because we’re about our patients, “I’m just going to talk my patients” as this is the most important thing.

‘This is why nurses haven’t stood up for themselves… because they’ve always put the patient first.’

Concluding her hopes, Young reaffirms the importance of GPNs and the need to hear their voices at a senior policy level.

‘None of us who are doing this have an official role to do so but we’re using our seniority to highlight this, because we feel a real impetus and a responsibility on us to advocate for the next generation,’ she says.

‘Nursing is an art and a science… we can tell stories, we can make things make sense and we make things understandable, but not in a patronising way.

‘We can prescribe so we’re independent, we can set care, we can do the episodes of care, we can discharge, we can refer to the specialists ourselves.

‘We don’t need to have somebody else, which [some] other roles do.’