Developing and supporting extended nursing roles: the challenges of NHS walk-in centres

Abstract

Background: National Health Service (NHS) walk-in centres offer immediate access to nurse-led primary care. Forty 'pilot' centres are now open, of which nine are in London. In providing clinical assessment, health information and a limited range of treatments to users, they exemplify new nursing roles that are emerging in primary care.

Aim: To describe the emerging roles of walk-in centre nurses, and explore the causes of role stress and review arrangements for training, development and support. METHODS; Semi-structured interviews with 29 managers and nurses from the nine London walk-in centres and with 10 stakeholders providing other primary care services near to three of the walk-in centres. Findings. Walk-in centre nurses are drawn from a wide range of clinical backgrounds. Emerging roles include diagnosing, developing clinical management plans, prescribing and discharging patients. Most find the roles challenging, but at times also stressful. There is no consensus on the most appropriate nursing skill mix for a walk-in centre nor on the core competencies required by the nurses working there. As a result there is no standardization of induction, training or support for walk-in centre nurses - particularly on the balance between taught and apprenticeship-type training.

Conclusions: Agreement is required on the competencies required for walk-in centre nursing and on appropriate ways to develop and support nurses in their practice. Lessons could be learned from general practitioner training.