Competency Framework for GP Practice Nurses

Overview: This competency framework outlines the essential competencies for nurses in NHS England general practice (GP) settings, divided into general competencies (broad skills and standards for primary care nursing) and hypertension-specific competencies (focused on managing high blood pressure, a common GP long-term condition). The framework aligns with national standards (NHS, NMC, NICE) and defines competency levels to guide development from novice to expert. Assessment criteria are included to evaluate competency at each level.

Competency Levels and Progression

Nurses are expected to progress through competency levels as they gain experience in general practice. This framework uses three levels (aligned to NHS career framework levels):

• Foundation (New to Role/Band 5): A newly registered GP practice nurse. Requires guidance and supervision for unfamiliar tasks, and focuses on learning protocols and safe practice.

• Proficient (Experienced/Band 6): An independent, competent practice nurse. Capable of working autonomously in routine care, with solid knowledge of guidelines and the ability to plan and prioritize care. Recognizes limits and seeks advice for complex situations.

• Advanced (Expert/Band 7+): A highly experienced or specialist nurse (e.g. Nurse Practitioner). Demonstrates expertise in clinical care, leads on service improvements, and can supervise and teach others. Often manages complex cases and contributes to practice leadership.

Assessment of competency is holistic and multi-method – there is “no generally accepted ‘gold standard’” for competency assessment. Therefore, a combination of direct observation, evidence of knowledge (courses, certifications), case reviews, and feedback from colleagues/patients is recommended. Each level builds on the previous, with increasing independence and complexity of skills.

1. General Competencies for GP Practice Nurses

These are core competencies all practice nurses should demonstrate, encompassing clinical, professional, and operational domains. General competencies ensure that even if a nurse specializes (e.g. in a chronic disease area), they maintain a baseline of ability across the broad GP nursing role ().

1.1 Clinical Skills

GP nurses provide front-line clinical care across the lifespan, so they must master a range of clinical skills:

• Fundamental Clinical Skills: Conduct accurate patient assessments and observations – e.g. measuring blood pressure, pulse, respirations, temperature, height/weight (BMI) – following evidence-based procedures.

  • Foundation: nurses perform these with supervision or by closely adhering to protocols;

  • Proficient: nurses competently perform assessments independently and recognize abnormal findings;

  • Advanced: nurses act as experts, able to troubleshoot equipment or atypical results and teach others proper technique.

  • Assessment criteria: Direct observation (e.g. a senior nurse observes a blood pressure measurement to ensure correct cuff size, both-arm measurement, and proper technique, and review of recorded vital signs in patient notes for accuracy and completeness.

• Clinical Procedures: Safely perform common treatments and procedures in primary care. This includes injections and immunisations, wound care and dressings, venepuncture (drawing blood), ECG recording, assisting minor surgery, and infection control practices.

  • Foundation: the nurse has been trained and signed off on each procedure and follows step-by-step guidelines.

  • Proficient: the nurse efficiently performs procedures, anticipates patient needs (e.g. pain relief, anxiety) and ensures infection control.

  • Advanced level: the nurse might introduce new techniques or run clinics (e.g. travel vaccinations) and mentor juniors in procedural skills.

  • Assessment criteria: Demonstration of each skill to a competent assessor for sign-off (using competency checklists or Direct Observation of Procedural Skills), and periodic audits of technique (e.g. vaccination technique assessed against Public Health England standards).

• Emergency Response: Recognize and initially manage urgent or emergency situations in the practice. All levels must know protocols for acute events like collapse, anaphylaxis, asthmatic attack, stroke symptoms, etc., and act promptly according to practice policy.

  • Foundation: will alert senior staff and initiate basic life support if needed;

  • Proficient: nurse can independently perform first-line interventions (e.g. administer oxygen, anaphylaxis kit) and call emergency services;

  • Advanced: nurse can lead the emergency response until a GP or ambulance arrives, and afterwards review the incident for learning.

  • Assessment criteria: Simulated emergency drills or scenario-based assessments to test response (e.g. a mock anaphylaxis where the nurse is expected to use the correct dose of adrenaline). Documentation review can confirm the nurse appropriately records and communicates critical incidents.

1.2 Professional Standards

Nurses must uphold professional standards as defined by the Nursing & Midwifery Council (NMC) Code and other regulatory guidance. The NMC Code is structured around four themes – “prioritise people, practise effectively, preserve safety and promote professionalism and trust” (The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates - The Nursing and Midwifery Council) – which underpin expected behaviours. Key competencies include:

• Ethical and Legal Practice: Maintain patient confidentiality, dignity, and informed consent in all interactions. For example, a competent nurse follows data protection law and RCN confidentiality guidance when handling patient records.

  • Foundation: the nurse knows to seek advice when facing ethical dilemmas;

  • Advanced: the nurse can lead on confidentiality training and act as a safeguarding lead if needed.

  • Assessment criteria: Feedback from patients (e.g. via surveys or compliments/complaints) and observation of consultations to ensure the nurse respects privacy and obtains consent appropriately. Adherence to safeguarding procedures (e.g. proper escalation of any concern) can be evaluated via case discussions.

• Accountability and Continuing Development: Practice within own competence and seek help when needed. A nurse at any level must recognize the limits of their scope and adhere to local patient group directions (PGDs) or prescriptions for treatments. Continuing professional development (CPD) is expected: e.g. completing mandatory training (infection control, basic life support) and pursuing further qualifications (like chronic disease management courses). The nurse should maintain a portfolio for NMC revalidation, including reflections and evidence of training. Higher-level nurses might undertake mentorship or leadership training.

  • Assessment criteria: Review of the nurse’s professional portfolio (checking that they *“maintain accurate records as evidence for revalidation…and retain certificates as evidence of training” ()), as well as appraisal discussions to ensure engagement in CPD. Manager feedback can confirm the nurse appropriately seeks supervision for new tasks.

• Communication and Teamwork: Communicate effectively with patients, families, and the multidisciplinary team. This includes skills in patient education, motivational interviewing, and collaborating with GPs, pharmacists, and other staff. All levels should demonstrate clear record-keeping and handover of care.

  • Foundation: a nurse may rely on communication templates or senior guidance for difficult conversations;

  • Proficient: they adapt communication style to patient needs (for example, using simpler language or interpreter services) and actively participate in team meetings;

  • Advanced: they may lead team huddles, mentor others in communication skills, and contribute to practice policies (like developing patient information leaflets).

  • Assessment criteria: Observation or recorded simulations of nurse-patient consultations can assess communication clarity and empathy. Multi-source feedback (360° feedback from colleagues) can gauge teamwork and professionalism in interactions.

1.3 Operational Knowledge

Operational competencies refer to understanding how the GP practice and wider primary care system operate, ensuring the nurse can work efficiently and safely within it:

• Practice Systems and Policy: Understand and utilize clinical IT systems (such as EMIS or SystmOne) for documenting patient encounters, coding diagnoses, and retrieving results. The nurse must maintain high-quality documentation in line with NHS and Care Quality Commission (CQC) standards – e.g. “ensure accurate documentation/record keeping… in line with practice policies and NMC guidelines”. They should also know how to navigate the appointment system, recall systems (for immunisations or chronic disease reviews), and referral pathways.

  • Foundation: a nurse can enter data and follow templates with some checks;

  • Proficient: they efficiently manage electronic records, run reports (e.g. identify patients due for review), and follow protocols for referrals (like two-week-wait referrals for suspected cancer, via the GP);

  • Advanced: the nurse might train others on the IT system, perform clinical audits, or coordinate recall programs (for example, improving the hypertension register). Assessment criteria: Audit of clinical records entered by the nurse for completeness and accuracy, and direct observation of the nurse using the IT system (or a skills checklist for EHR use). Successful completion of any relevant information governance training is also an assessment item.

• Organisational Understanding: Possess knowledge of NHS primary care structures and quality programs. This includes familiarity with the GP contract and Quality and Outcomes Framework (QOF) indicators (e.g. knowing that patients with hypertension need at least annual BP checks recorded), local care pathways for common conditions (like referring to smoking cessation services or specialist clinics), and policies like infection control, medicines management, and health and safety.

  • Foundation: nurse knows the basic policies (fire safety, waste disposal, cold chain for vaccines, etc.) and where to find guidance.

  • Proficient: nurse ensures daily operations run smoothly – for instance, checking vaccine fridge temperatures, stock control of clinical supplies, and participating in significant event audits.

  • Advanced: nurse may take on lead roles such as Infection Control Lead or Practice Educator, and contributes to developing or updating practice protocols.

  • Assessment criteria: Completion of required statutory training (infection control, information governance, etc.) can be tracked. Assessors might use a quiz or interview to test the nurse’s knowledge of key operational policies (e.g. “What is the protocol if a vaccine fridge goes out of range?”). Evidence of participation in meetings or contributions to policy updates (meeting minutes, written protocols) can demonstrate higher-level operational engagement.

1.4 Assessment of General Competencies

To evaluate general competencies, a variety of methods should be used (as recommended by NHS and NMC guidelines):

• Direct Observation: A senior nurse or assessor observes the practice nurse in real clinical scenarios or simulations. For example, observing a wound dressing change or a hypertensive patient consultation assesses both clinical skill and communication in real time. A checklist may be used to mark key steps performed correctly (aseptic technique, patient consent, etc.). Repeated observations over time can track progression from needing guidance to full independence.

• Case-Based Discussion and Reflection: The nurse presents cases (e.g. a complex diabetic patient they managed) for discussion with a mentor. This assesses clinical reasoning, application of guidelines, and recognition of one’s limits. Reflection write-ups (required for NMC revalidation) also serve as evidence that the nurse can evaluate their practice and learn from experience.

• Knowledge Assessment: Completion of e-learning modules or in-service training (for example, a NICE guidelines update on hypertension) can be used to verify knowledge. Short quizzes or scenario questions in appraisal can ensure the nurse knows critical protocols (e.g. emergency drug doses, referral criteria).

• Feedback and Audit: Multi-source feedback from colleagues, and patient feedback, provide insight into professional behavior and communication. An audit of the nurse’s clinical work (for instance, checking 10 hypertensive patient records to see if care followed NICE guidance) can objectively measure adherence to standards. Consistently meeting QOF targets for their cohort of patients could indicate effective performance.

• Portfolio Review: A regular review of the nurse’s professional portfolio ensures they are documenting competencies. Evidence might include certificates of training, records of supervised practice, and logs of procedures performed. This aligns with NMC revalidation requirements and helps confirm that the nurse “seeks and applies new knowledge and research findings” at higher competency levels.

Combining these methods provides a robust evaluation – as noted, a “multi method approach” improves reliability of competency assessment. Clear assessment criteria should be defined for each competency (e.g. a competency checklist outlining the steps or knowledge required), and the nurse should be deemed competent when they can demonstrate the skill or knowledge consistently to the standard expected without direct supervision.

Summary Table: Competency Domains and Levels

Below is a high-level summary of how a nurse’s competency develops across the defined levels for the main domains:

Assessment Note: Progression from one level to the next is demonstrated by meeting clearly defined criteria in each domain. For example, to move from Foundation to Proficient in Clinical Skills, a nurse must show they can practice safely without direct supervision, applying evidence-based guidelines consistently (. The practice should document competency sign-offs, mentor feedback, and any exam/course completions as evidence. Regular appraisals will use the above domains to structure feedback, ensuring the nurse develops all-around competency (clinical, professional, operational) in general practice, as well as disease-specific skills like hypertension management.