Deborah Taylor – Westleigh Medical Practice, Wigan CCG

What apprenticeship are you studying and what does the study involve?

I am currently a second year Trainee Nursing Associate at Salford University (September 2020 cohort). I was originally due to start in March 2020, but due to the pandemic, the starting date was delayed. As the pandemic continued the decision was for us to start our foundation degree online. So not only was this the first cohort to train Primary Care TNAs but also for us to primarily learn virtually, which was new to not only the students but the clinical educators which is something we all had to learn to adapt to.

One day a week I attend university either face to face or most online.

Within my working week, I incorporate time that is protected for learning, this can include online webinars, training from e-learning for health and similar training courses as well as spending time with other healthcare professionals in our MDT model of practice such as, GPs, Advanced Nurse Practitioners, Prescribing Practice Nurse, and Clinical Pharmacist.

As the Nursing Associate is a generic role, I have needed to gain experience in all four fields of Nursing (Adult, Learning Disability, Mental Health and Children and Young People).  Luckily in Primary Care, I get the exposure of working, with patients that can fall into not just one but sometimes multiple categories. The underpinning knowledge, skills and behaviours taught from university have certainly helped in providing holistic care to support the patient, their families, and the wider healthcare team. I feel I have been proactive in finding time to organise bespoke placements to further help me achieve the proficiencies set.

In terms of assessments these have been either a professional discussion, written essay, or exam questions in open book format. I personally found the professional discussions more suited to me (I love to talk!), but I am putting my all into every exam, knowing I have tried my best.  As a mature student, working full time and being a mum/housewife, I wondered how I would fit it all in and now on reflection I can’t believe it’s nearly all finished.

Why did you want to do the apprenticeship?

I’ve always really wanted to be a Nurse, from leaving school, but life took a different path and I enjoyed working for a wage rather than studying. Then I had my children and felt it was just a pipe dream. When the opportunity arose to take this route to be a Registered Health Care Professional, I took it with both hands and ran with it.

What is your current role?

As a Trainee Nursing Associate in Primary Care, and being in the first cohort, it has been a great opportunity to work with Practice to tailor the role to suit the practice and patients’ needs.

After spending time with the Practice Nurse shadowing various chronic disease management reviews, we worked on starting to complete asthma reviews, under direct supervision, then under long arm supervision, working to Greater Manchester Medicines Management Group guidelines.

I also still carry out my original Health Care Assistant duties but currently a new patient medical may be more in depth if they have a chronic condition, now that I have a vast knowledge of the drugs they are taking, their side effects, symptoms of the disease and the National Institute for Health and Care Excellence algorithms. All of this I have learnt by giving what I now know to be Situation Background Assessment Recommendation handovers, as we are a training practice, the clinicians then discuss with me my recommendations, they encourage me to reflect and to self-assess which furthers my knowledge.

How did you get into your current role?

I’ve only ever worked in healthcare in the practice I work in now, which I started seven years ago, as a medical receptionist. I was trained in completing NHS Health Checks and put myself through both NVQs Level two and three in Health and Social Care in my spare time.

I then became a Health Care Assistant full time. I always wanted to be a nurse and follow in my late Grandmothers footsteps, so this felt like I was getting the opportunity to have a taste of a clinical role. I enjoyed my role, at the Greater Manchester Primary Care Conference, I was speaking to the clinical lead of the Greater Manchester Training Hub for Wigan and Bolton, Sam Howard. Sam advised me the Nursing Associate Apprenticeship was going live and the first pilot with Primary Care was starting soon, she sent me all the relevant information quickly as the deadline was approaching the Practice Partners, Emma White & Wendy Fairhurst alongside my Practice Manager Sharon Sargent were brilliant at prioritising everything to ensure I got on the course.

What has been your proudest achievement on your apprenticeship to date?

It is hard to define just one proud moment. I am proud of myself for coming this far in the training, when times have been tough I’ve strived to carry on succeeding.

As a cohort I think we all need to be proud of the fact that, not only are we frontline staff in a pandemic but also for studying for this foundation degree.

I also helped to diagnose a patient with type 2 diabetes, who I sat with when he cried at the news, and then several months later, had reduced his blood sugar from over 100 to 41, and started to reduce his medications, he then thanked me for all the support and education I had given him. That was really humbling, to me it was my job, but to him it’s his life, being able to reduce his cardiovascular risk factors was very rewarding. Primary Care often gets overlooked as we don’t have the drama that is seen in Secondary Care, but what people often forget is that it’s our job to support patients to maintain their health to reduce Accident and Emergency attendance or provide their care following a hospital stay.

I am also the key contact for a young adult with learning disabilities and mental health issues, I am involved in the multidisciplinary team meetings with the community teams involved, after three failed referrals into Mental Health, I managed to escalate her case to be triaged and she is now receiving the help needed.

Thirdly, promoting the role of Trainee Nursing Associate at an online event to GP Practices in Cheshire and Merseyside, alongside their workforce lead for Health Education England in the North West. Here I talked about how my role had developed from Health Care Assistant, how being a second year Trainee Nursing Associate differed from in my first year, and how I incorporated my study into my working week. I was also asked many questions at the end and received some lovely feedback after the event.

What do you want to do once you complete your apprenticeship?

Well, I am honestly looking forward to a holiday! But after that, I am going to access my preceptorship including cytology and further immunisation training so that I will be able to perform smears and added immunisations such as baby vaccinations.

I said in my interview that my dream is to be an Advanced Nurse Practitioner in General Practice, I have been inspired by the colleagues I have worked with.  I hope that I am able to complete my top up training to be a registered nurse and then hopefully revisit studying at master level as a 10 year goal.

As it is clear to see that the Nursing Associate role in Primary Care is really taking off, and I have seen recruitment adverts for Trainee Nursing Associates within the Primary Care Networks of Wigan CCG, I would like to be a contact for them in the future in order to support them.

What would you say to someone considering an apprenticeship?

When I was applying for my place on the apprenticeship, I worried about how I would overcome obstacles such as childcare when on placement, or when in university as these hours would differ from what I’ve worked previously.

One of the partners at the practice gave me the advice of following what I wanted to do, and overcoming each obstacle as they approached, rather than worrying about what possibly could obstruct me before they did or did not happen. This was exactly what I needed to hear, and exactly what I did. I would echo that to any future Trainee Nursing Associates, to go for it.

Even as an experienced Health Care Assistant, I wondered if this was the right path, but it absolutely was, I have not only recognised the skills, knowledge, and behaviours I already had, but the underpinning knowledge which is invaluable to the role.