WHEN we’re ill, our GP surgeries are the first place we turn for help. But who we’re seen by is changing, with some patient care moving away from under pressure doctors. In our series, Changing Care: The new GP team, we’re looking at what patients in North Cumbria can expect.
Today the practices’ unsung heroines and heroes - nurses.
Julie Dawson recalls when there were just four practice nurses in her team. That’s multiplied to 28 now, part of a new wave of highly trained healthcare professionals needed to tackle growing demand.
Julie is Nurse Team Lead at Carlisle Healthcare. As well as her management role she also has a speciality in diabetes. And few things demonstrate the challenges faced by the NHS more graphically than the explosion of people now requiring help to manage that condition.
In a primary care network covering some 37,000 people, around 2,000 have diabetes, with a further 1,000 at risk of developing the condition. It’s little wonder the healthcare workforce has had to expand to meet the issues faced.
Julie explains: “Years ago we had a diabetic GP lead in the practice and everything went through him.
“As the numbers increased, we all needed to upskill to a point where all our long term condition clinics are now nurse-led.”
Lifestyle factors have played a huge part in the increase in type 2 diabetes. It used to be predominantly associated with the ageing population, but what Julie and her team are seeing is people developing the condition in their 30s, 20s and even teenage years. The growth in demand means a changing focus.
Julie said: “We do encourage patient education and self-care. When we first started this process, many people weren’t keen. It was like, ‘you’re the clinician, you tell me what I should do’.
“But we know that people make their own choices and do what’s important for them, and typically this isn’t what they are ‘told to do’. We have spent many years developing a care and support planning approach, working with people to identify their goals and actions and supporting them in their positive behaviour change.
“Now when people come to see us they may have already identified a plan to improve their health and reduce their future risk of complications. This approach has transformed how we work, and allowed us to focus more on the person, rather than the disease.
“Our biggest challenge is working with people who are not motivated to change.”
Diabetes is far from the only long-term condition affecting large numbers of the community. Heart problems, high blood pressure, respiratory conditions, strokes and kidney disease are also significant. Clinics for long term conditions at Carlisle Healthcare and across North Cumbria are busy places.
Sarah Sewell was a nurse who wanted to be able to do more to help the patients she was seeing. After three years of further study and training she is one of a growing number of Advanced Clinical Practitioners (ACP).
Sarah said: “It’s about bridging the gap because there are not enough doctors around. A lot of things can be managed by us, we can diagnose, treat and prescribe and we can do the ongoing referrals for further tests. We carry our own caseload of patients.
“A lot of us were nurses first and we don’t lose that nurse within us, but it’s about us extending the roles so we can give the right care to the right people at the right time. That frees up the GP’s time to look at more complex conditions.
“It was sometimes frustrating to be a nurse and you could see there was a problem, and you were constrained by ‘well that’s where my role ends’. Now there are options to go on and extend your skills.”
Some ACPs have specialist roles such as running well woman clinics, HRT, respiratory issues or paediatrics, as well as seeing the full range of illness and poor health.
Sarah said: “We see people from cradle to grave, at every stage in their life.
“Nine out of 10 people are more than happy to see us. For younger patients we’ve always been around in the background but for older generations this is new and different from where we used to be.
“We all want the same thing - for people to get good quality care. That’s not always easy, we are constrained by time, money, pressure and lots of other things. It is about us all working together.”
READ MORE: Questions are for the patient’s own good
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