How does a nurse practitioner run a successful GP practice? Charlotte Hudson chats to Carol Sears who is the clinical director of The Cuckoo Lane Practice in Hanwell, London

The Cuckoo Lane Practice is a small nurse-led practice, run by two directors, Carol and Julie, who are both nurses; this turns the traditional model on its head. They offer a full general practice service to 4,500 patients.

Carol has had a varied medical career – spanning 24 years in general practice, she has worked as a midwife as well as a nurse.

“Like a lot of nurses who come into general practice, I was recruited by my own GP during my time working as a midwife doing night duty when my children were very little. The GP I was registered with asked me to go and work at his practice, so in the late 80s I finally tried practice nursing and fell in love with it. I was encouraged by the previous GP partners to do the nurse practitioner course, which at the time was a degree level course and is now a Masters course, and in 1997 I qualified as a nurse practitioner,” Carol says.

Carol developed the role of the nurse practitioner at the practice and carried on working with the GP partner until they both decided to retire. Having a good relationship with the GP partners, Carol put in an application to run the practice and she took over running it, with her colleague, Julie, in 2005 – beating 11 other GP providers to the post. Carol still maintains a clinical role in the practice and provides seven clinical sessions a week.

The staff ratio is two doctors to six nurse practitioners, out of 20 staff. How do the GPs find having a nurse practitioner as their director? “We try to surround everybody who works in the practice with a good system of clinical governance,” explains Carol. “We have two doctors who work with us on a regular basis offering sessions every day, but they don’t get involved with the managing and the running of the practice so we try and make sure that they are happy in their jobs by arranging for them to see those patients that want to see the doctors and also seeing patients who we think would be suitable to see the doctors, as well. Generally we all get on very well.” 

Commissioning

At the practice Carol and Julie are very aware of the costs of healthcare: patient episodes, prescribing, medication, A&E attendances, procedures that patients need, and they keep on top of this. Carol is involved in low-level commissioning. She attends the commissioning group meetings and she was on the working party for the commissioning the new ophthalmic service, which has led to a new community ophthalmic service being commissioned locally.

“One of the things I think is very important is to do as much as you can in general practice for your patients and to get to know what your other colleagues can do in other practices,” says Carol.

Carol’s practice refers to other practices across their patch, so for instance, they’ll refer to GPs with a special interest in joint injections and other practices will refer to their practice for things like the provision of ring pessaries for uterine prolapses. They also do paediatric phlebotomy for other practices.

The surgery is on a small site, inside a converted semi-detached house. Carol says they are looking to move to more purpose-built premises so they will be able to expand the services they offer.

“As we are nurse-rich, I’d like us to provide other nursing type services – we have some very experienced practice nurses and nurse practitioners in the practice. I’ve just been in a meeting of leadership nurses, and one of the things we are trying to develop is working in conjunction with the commissioning group on leading practice nurse and HCA education across the patch,” says Carol. 

Online booking facility

Patients are able to book appointments online using Emis access, and Carol says she is actively encouraging more patients to book this way.

“I think it is very important that patients are able to book online but not enough patients are using the system at the moment. The more patients that use it, the easier it is for us really – so long as they book with the right person! Sometimes we get the odd mess up where a patient has booked with a phlebotomist when they really wanted an appointment with a GP.” 

"Like a lot of nurses who come into general practice, I was recruited by my own GP during my time working as a midwife doing night duty when my children were very little"

Favourite part of the job

“Seeing the patients is my favourite part of the job,” says Carol. “I enjoy the continuity, I live and work in the same patch so I’m now starting to see young women have their babies and I saw them when they were babies, too. There is mutual trust built up over the years with families who are registered in the area, and it’s a privilege to be involved in people’s lives, from the beginning to the end.

“General practice and primary care is a wonderful area to work in if you can give it the time and energy that it deserves. It’s very hard at the moment because there’s so much pressure on general practice to be part of all these different initiatives, which often detracts from the one-to-one consultation – but making a connection with a patient and helping them on an individual level is what I like most.”

Carol also works for MPS as a freelance Clinical Risk Self Assessment (CRSA) facilitator.