An improved profile for GPNs with appropriate redistribution of resources to support them moving forward.
The NHS is now three years into the most radical set of reforms since it was established in 1948. We have seen changes to commissioning and provision, and following the publication of the Five Year Forward View (NHS England, 2014) will continue to see changes to service delivery at every level.
This feature asks experts in their particular field to take a look at a therapy area and examine some of the challenges that general practice nurses (GPNs) may face. In this issue, we look at how...
Innovative compression therapy systems can improve practice
The problem:
Treating leg ulcers makes up a large part of a nurse’s caseload. While compression therapy with graduated multilayer bandaging has been widely accepted as recommended treatment, patients can find it bulky and uncomfortable and clinicians need to be trained and competent in its application. Thus, it is important that clinicians keep up to date with new methods of compression that can promote concordance, improve healing rates and achieve cost savings — all vital elements in leg ulcer management. Juxtacures™ (medi UK), an adjustable compression system, is one such innovation that helps to alleviate some of the challenges associated with multilayer bandaging.
*This piece was sponsored by an educational grant from medi UK
Recently it has become clear that hormone replacement therapy (HRT) is a safe option for many women. The National Institute for Health and Care Excellence (NICE) published a guideline in November 2015 which provides guidance as to when HRT can be used and what risks and benefits are associated with its use. HRT is the best treatment available for management of menopausal vasomotor symptoms. If started before the woman turns 60 and within ten years of the menopause, HRT has a good safety profile. The main risks associated with HRT use are venous thromboembolism (VTE), stroke and breast cancer. VTE and stroke risks are increased when oral HRT is used. The increased risk of breast cancer is linked to combined HRT use. HRT is bone protective and can prevent osteoporosis. It is recommended that HRT is used for the shortest time possible, and if used for five years or less serious side-effects are unlikely to occur.
General practice nurses (GPNs) are well placed to ensure that patients with respiratory conditions receive high quality, safe, effective, evidence-based care. The National Review of Asthma Deaths (NRAD) (Royal College of Physicians [RCP], 2014) found that two out of three asthma deaths could have been prevented with better routine care. The key components of good asthma care, including the importance of correct inhaler technique, were highlighted by this landmark report. Poor inhaler technique is known to adversely impact upon control of respiratory disease and its symptoms. In 2013, the National Institute for Health and Care Excellence (NICE) published Asthma Quality Standards. However, NRAD found that despite the existence of such solid recommendations and guidance there were potentially avoidable factors related to the implementation of national guidelines in 46% of the deaths that were reviewed. Most recently, the Chronic Obstructive Pulmonary Disease (COPD) Quality Standard was added as an update to COPD guidance (NICE, 2016). Both documents include quality standards around inhaler technique.
Chronic kidney disease (CKD) is an ongoing decline of renal function which may progress quite rapidly or develop slowly over many years. Due to the nature of the disease, it is linked to cardiovascular disease (CVD) and a host of symptoms, comorbidities, high mortality and reduced quality of life. The majority of CKD patients will be identified in primary care. Once diagnosed, patients are likely to become increasingly frequent attenders within general practice. It is therefore useful to have an overview of the disease process and the multifaceted care needs of this specific patient group. General practice nurses (GPNs) are vital members of the multidisciplinary team who are wellplaced to identify, monitor and provide ongoing support for patients with CKD.
Despite the widespread reported health benefits associated with increased physical activity (PA) and exercise, in reality, a large percentage of adults and children in the UK today are inactive and levels of obesity and life-threatening conditions associated with sedentary and unhealthy lifestyles are increasing (National Institute for Health and Care Excellence [NICE], 2015). Chronic diseases are on the increase, including diabetes, hypertension, bone and joint diseases, cancer and depression, and are affecting both the young and old. Regular PA can guard against these life-changing conditions (Public Health England [PHE], 2014). General practice nurses (GPNs) are ideally placed to advise patients about the benefits of PA. This article provides an overview of recommendations and any safety aspects, current fitness terminology, as well as the importance of exploring patient perspectives in terms of perceived barriers to PA.
INTEGRATING CARE FOR LONG-TERM CONDITIONS IS IMPORTANT
Improving management of people living with long-term conditions (LTCs) has been a key priority for the NHS since the 1990s. At the time, little evidence existed to understand the best practice on managing LTCs and the involvement of primary care. Today, we are in a stronger position where efficacy, safety and other positive outcomes are being demonstrated by implementing a variety of quality improvement approaches and service redesign, all underlined by the rhetoric of integrated care.
In each issue of the journal we speak to general practice nurses and hear what they have to say about their role in primary care. This time we hear from Paula McLaren, nurse practitioner, Watling Medical Centre; research lead and health and wellbeing lead, Colindale and Burnt Oak Clinical Network.
Welcome to GPN’s learning zone. By reading the article in each issue, you can learn all about the key principles of subjects that are vital to your role as a general practice nurse. Once youhave read the article, evaluate your knowledge on this topic by answering the 10 questions in the e-learning unit; all answers can be found in the article. If you answer the questions correctly, you can download your certificate which can be used in your continuing professional development (CPD) portfolio as evidence of your continued learning and contribute to your revalidation portfolio.
This article highlights the role of general practice nurses (GPNs) in the care of a variety of wounds that are becoming
increasingly commonplace in primary care. GPNs have a unique opportunity to develop their skills in this field, articularly as there is a plethora of wound care products available to them on prescription. However, it is also the GPN’s professional duty to ensure that they have the understanding and knowledge necessary to use these products in a way that benefits patients clinically as well as providing cost-effective care.
