Implementation of the nursing associate role in general practice: five qualitative case studies in English primary care

Topping, Annie Hoi Yin (2023) Implementation of the nursing associate role in general practice: five qualitative case studies in English primary care. Doctoral thesis, Northumbria University.

Preview

Text (Doctoral thesis) topping.annie_dba (16036183).pdf - Submitted Version Download (2MB) | Preview

Abstract

Workforce shortages in the NHS are an on-going challenge, particularly in nursing and primary care. In response, the government introduced initiatives aiming to expand the numbers of Registered Nurses in primary care. One of these is the introduction of the Nursing Associate (NA) role in England. To date, there is limited empirical evidence as to how the role has been implemented, and none that has focused on primary care.

This research study has investigated how, why and to what extent the NA role has been implemented in general practice. Through qualitative comparisons of five case studies in the North East of England, the enablers and barriers for role change and institutionalisation have been examined.

Semi-structured interviews and focus groups were conducted with stakeholders: NAs, General Practitioners; Managers (practice or nurse); and Nursing Teams. Template analysis with a priori themes was used to analyse the data.

Research findings show key themes of implementation challenge: (1) role clarity and place of new role; (2) role identity and transition; (3) tension at professional boundaries; (4) education and training gaps; and (5) future of the new role in terms of demonstrating added value and additional impact. The research concludes that NAs are not at this early stage able to fill the skills gap.

This study makes contributions to practice. It is the first of its kind to research the NA role in general practice and has also filled evidence gaps in under-researched areas, namely new work roles in healthcare and primary care. The study also has made potential contributions to institutional theory. It has tested the Elaborated Institutionalisation Model for new work role (Kessler et al., 2017), and suggested a 'modified' version for further research.

Finally, the study has made 16 recommendations for professional practice at both policy and organisation levels in four areas: education and training programme; professional identity; development for GP practices; and communication. There are opportunities to enhance the quality assurance system for educational providers and ensure the curriculum and clinical placements are meeting the needs of primary care. Primary Care Networks (PCNs) are well placed to influence the current gap in the provider market for topic-based training specifically for NAs.

More could be done by the Integrated Care Boards and PCNs with GP practices to provide clarity to NA role and construct a professional identity. These include a generic job description, consistent scope of practice, and reduction of the overlap with the Healthcare Assistant role. Peer support network and preceptorship programme are also key to developing the new role as well as the identity of individuals. GP practices should be supported to develop their capabilities and capacity in change management and workforce planning.

Looking ahead, the possibility for NAs to administer medications under a Patient Group Directive should be explored. A national and regional media campaign is critical to raise public and professional awareness of the new NA role.

Actions (login required)

View Item

Downloads