Integrating General Practice Nursing and Community Nursing: An Evaluation of the Rushcliffe Integrated Pilot Scheme

Rushcliffe MCP commissioned DMU to evaluate a pilot scheme focusing on the gaps and overlaps between Community/District Nursing and General Practice Nursing. Four new nursing appointments were implemented for 12-month training and development opportunity where they took part in mixed General Practice Nursing and Community Nursing roles and training. This is the final report submitted to Rushcliffe MCP which documents an in-depth evaluation of the integrated pilot model. Both quantitative and qualitative analyses are reported. BACKGROUND: Currently, there is an increasing focus on integrating areas of primary health care. Rushcliffe Multispecialty Community Provider (MCP) have implemented a pilot scheme, focusing on the gaps and overlaps between Community/District Nursing and General Practice Nursing. Four new nursing appointments were implemented for 12-month training and development opportunity where they took part in mixed General Practice Nursing and Community Nursing roles and training. This evaluative study explored the extent to which this integrated model could be sustainable for delivering nursing services in the future. The following research questions were developed:

RQ1) What are the experiences of the four nurses regarding their expectations, development of skills, competence, confidence and knowledge? RQ2) What are the strengths, weaknesses and challenges of the Integrated Nursing Pilot Scheme from the perspectives of the nurses, supervisors, mentors and patients? RQ3) How can the scheme be sustained and adopted into future workforce plans?

METHOD: Participants included four Nurses who were assigned 12-month appointments as part of the Rushcliffe Integrated Pilot Scheme, their supervisors/mentors (N = 7), the wider PHCT workforce (N = 5) and eight patients who received care from the four integrated nurses. A mixed-methods approach was used, whereby the dominant method of data collection and analysis was qualitative, supplemented by a small amount of quantitative questionnaire data to examine the patient experience. The data collection occurred at several stages over approximately a six-month period, incorporating qualitative semi-structured interviews with the nurses and their mentors/supervisors, a focus-group with members of the wider PHCT and mixed-methods questionnaires completed by the patients. Data were analysed using a thematic approach.

FINDINGS: Thematic analysis was conducted on all qualitative data. Three themes were identified which were pertinent to the research questions. The first theme encapsulated the trainee nurse experiences and focused on their motivations, expectations and their development of skills, strengths, knowledge, competence and confidence. The second theme focused on the focused on the perceived strengths of the scheme and reflected on qualitative data from the nurses, their mentors, the wider PHCT and the patients. The third theme addressed the future of the integrated scheme and focused on communication, insurance, training, reducing pressures, recruitment, funding and resources. The patient questionnaire generally revealed very high levels of satisfaction from patients regarding their experience of care from their integrated nurse.

DISCUSSION: The Rushcliffe Integrated Nursing Pilot Scheme aimed to examine how these areas of primary care could be better aligned to facilitate more holistic care for patients and explore new and innovative ways to attract more nurses into primary care. With an increasing focus on integrating areas of primary healthcare, this training opportunity has provided an innovative example of how integration can successfully operate from the perspective of the nurses involved.