Enhanced Practice Nurse

Overview

Enhanced practice is a level of practice within the healthcare workforce. It covers the graduate professional workforce delivering the majority of clinical activity, those who have moved beyond novice/competent and who are not working at the level of advanced practice.’ (NHSE, 2024)

Enhanced level nursing describes a level that can only be delivered by registered nurses who have gained additional post-registration education and experiential learning in a relevant subject area. This level can be applied to the full range of registered nurse careers. The enhanced level is differentiated from other levels by a registered nurse’s expertise in applying specific knowledge and skills to a designated area.  For example, this could be a client group, skill set or in an organisational context (RCN, 2024)

Scope of Practice

Role Responsibilities:

Registered nurses working at an enhanced level are expected to be able to manage discrete activities in complex, challenging and changing situations and environments. They should also be confident to seek further guidance when they reach the boundaries of their competence.

An enhanced practice nurse has the following key responsibilities in relation to delivering health services:

• Works as part of a multi-disciplinary team within the PCN
• Consults with patients, their family, and the multi-professional team to undertake assessment of patient needs and devise and evaluate complex care plans.
• Evaluates and analyses clinical problems using their clinical knowledge, seeking out and applying relevant evidence, enhanced techniques, interventions, and equipment to make clinical decisions.
• Delivers enhanced clinical care in the context of continual change, challenging environments, different models of care delivery, innovation and rapidly evolving technologies using analysis and their underpinning knowledge to manage complex interventions.
• Teaches and advises patients and their families on how to manage their condition or support the multi-disciplinary team to do so.
• Participates in clinical audits and research projects and implements changes as required, including the development, and updating of practice protocols/guidelines and procedures locally
• Works within national and local protocols where these exist;
• Recognises boundaries of their practice and know when and to whom patients should be referred using the principles of delegation, delegates work to other members of the MDT and take responsibility for the delegated activity as appropriate
• Demonstrates initiative and are creative in finding solutions to problems
• Holds responsibility for team performance and service delivery
• Provides supervision to trainee nurse associate, nurse associates and general practice nurses

‘NHSE 2024: Network contract DES: Contract specification 2024/25’

Entry Requirements

• Has completed a nursing degree or registered nursing degree apprenticeship (RNDA).
• Registered with the NMC
• Has a post graduate qualification at level 7 or above relevant to their area of enhanced practice, for example in wound care, diabetes plus respiratory and CVD, dementia, women’s health and public health and population health management.
• Is working at an enhanced level of practice as described in the Primary Care and General Practice Nursing Career and Core Capabilities Framework: Report template (skillsforhealth.org.uk)

‘NHSE 2024: Network contract DES: Contract specification 2024/25’

Training and development

Supervision requirements

Supervision is a process of professional learning and development that enables individuals to reflect on and develop their knowledge, skills and competence, through regular support from another professional.

Supervision can have different forms and functions and a number of terms are used to describe these. For this guidance we use the below terms and define them as follows:

• Clinic/practice supervision: day-to-day support provided by a named/duty senior/more experienced clinician for issues arising in the practice.
• Clinical/professional supervision: regular support from a named senior/experienced clinician/practitioner to promote high clinical standards and develop professional expertise.
• Educational supervision: supports learning and enables learners to achieve proficiency.

Supervision Guidance for primary care network multidisciplinary teams (NHSE, 2023): NHS England » Supervision guidance for primary care network multidisciplinary teams

Funding

AFC Band 7

100% of actual salary plus defined on costs covered via ARRS Scheme.

Training and Development Funding

Enhanced Practice Nurses may be entitled to wider NHSE commissioned funding to support their training and development requirements.  Please contact the training hub for more information on this.

Recruitment Information

Where a PCN employs or engages a Enhanced Practice Nurse under the Additional Roles Reimbursement Scheme, the PCN must ensure that the enhanced practice nurse meets the ‘Minimum Role Requirements’ stipulated in Annex B of the Network DES: Network Contract DES (england.nhs.uk)

Please find various resources in this section to assist in the recruitment and embedding of the Enhanced Practice Nursing role in General Practice.

Additional resources