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GPs "will be replaced by nurses on frontline"

GPs are likely to fade out of direct involvement with primary care and be replaced by specially trained nurses, an academic has said.

The professor at the National Primary Care Research and Development Centre suggests far fewer GPs than are currently employed are actually necessary.

Professor Bonnie Sibbald claims that as much as 70% of care in general practice could be delivered by nurses.

In an editorial published by the journal Quality in Primary Care, the professor writes: "So do we need doctors in general practice? The answer is probably yes, but far fewer than presently.

"Nurses can deliver most clinical care, leaving doctors to deal with that minority of patients who have complex medical problems."

Professor Sibbald said it was time to tackle the fact that a majority of practices are owned by GPs who are reluctant to hand control to nurses.

Royal College of General Practitioners chair, Professor Steve Field, said he was unconvinced by the idea.

"There's no doubt the role of the GP is going to evolve, but I really don't see it as a simple issue of needing fewer GPs as we pass work over to nurses," he said.

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National Primary Care Research and Development Centre

What do you think to this? Should nurses deliver most services in primary care? Your comments: (Terms and conditions apply)

"I am a PN and I think we already do deliver 70% of the service, but I would not be happy at all without the support of the DRs. We work as a team and I hope they value my input. I worry though this may be a way of getting more for less money in the end. I came into this profession to be a nurse not a DR." - Maureen, London

"Maureen, the bigger picture and progress, absolutely. But lets not forget payment linked to responsibilty. GPs have benfited, why not nurses?" - George Cimarosti

"I think nurses should not take 70% of the work in GP surgery because they will never get paid for it. But we still do 70% without pay. Nurses are not well represented in the government. We do all the job and GPs get paid 100%. It's not fair." - Kwenga Lele Zaya, GP surgery, London

"This is just another guise to get more for less! Patients find it difficult to see a Dr now, but getting rid of Drs and pushing the increasing care onto nurses is not the answer! Most nurses are more than capable of dealing with the vast majority of chronic care management, but cannot work as GPs. Our 3 years training does not compare to the lengthy training a doctor has to undertake; starting with a top class degree before even getting into medical school. And then the punishing rounds as a junior doctor; most of the GPs today have been through the 100 hours a week as the on-call doctors, which was considered the 'norm' in the 80s and 90s. We all take continuing training - but as nurses we did not go into our roles to be underpaid and undertrained doctors. As an autonomous practitioner and prescriber with a degree and much postgrad training, I am still more than happy to leave the ultimate responsibility to the doctor. A good and competent nurse is invaluable, but a good nurse working as an undertrained GP will eventually become unstuck." - Name and address supplied

"I beleieve that many aspects of work done in primary care practice could be done by nurses. Already nurses are taking over many of the roles that were done by GPs in the past." - Choo Wright, Surrey

"I work as as an RCN accredited nurse practitioner in general practice and agree that there is a large amount of work that can be done by suitably qualified nurses. I agree that it is about 70%. Unfortunately, there are primary care nurses who are not helping themselves or the public by taking on roles in general practice they are not qualified to do, not only putting themselves, but more importantly, putting patients at risk. Timely response from the NMC is required to clarify this. Practice nurses too have a lot to offer patients. Practice nurses, not only managing the day-to-day needs of patients, have often undertaken diploma and degree level courses managing chronic diseases, eg, COPD, asthma, diabetes. However, I agree we do need GPs to be available for complex health problems.
I cannot leave this without mention of money. Some will be saying 'using nurses are a cheap option' others not. Willing nurses working at advanced level, whether they be nurse practitiones or practice nurses, must be paid appropriately and given access and support to relevant training and updates. This unfortunately remains a problem for a lot of nurses. Some are still having to pay their own fees for courses and updates. Salaries is always a talking point. 'Agenda for Change' offers excellent guidance to GPs, ensure they know where to get a copy, it is available on-line from the RCN." - Rosalind, Slough

"Myself and my colleague deliver good quality chronic disease management, however, I am grateful that I have GPs that have had much more wider training than me to back up my care. They are two different roles that should compliment each other and give the 'all round care' that patients deserve. As nurses  are just as accountable and responsible, I do believe that we should be treated with greater respect by our medical colleagues. The GPs that pay our wages should recognise our extended roles through our wage packets and we should not have to go 'cap in hand' for any increases we feel we deserve. I feel GPs have now become business men and women without the man management skills to equip them to run a team of individuals - I still believe I am working for the greater good of
the patients in my care, but hey, a better pay packet would help to smooth over the husband that has had to put up with my tantrums near hand in dates for assignments etc. Thanks dear husband - my hero." - Teresa

"This would be a great challenge for some nurses who are competent, skilled, experienced, capable and confident to take on this role. I for one would rise to the challenge. Good for those aspiring nurses and good for the profession." - Violet Henry, London

"Maureen, I would be more than happy to take on more responsibility as I thrive on challenges. However, I feel this is a cost saving mission and not a patient quality of care issue which is what is so frustrating!!" - Sally, Midlands

"Many practice nurses have done extensive additional training since choosing to become a nurse and can competently run most areas of chronic disease, health screening, first contact, etc. I am booked two weeks ahead of the GPs I work with, and it is nice that doctors sometimes refer to me within the areas I have developed expertise. I consider there are also areas of medicine where I have had little experience and then I refer to a GP. Some consultants now accept direct referrals from myself, a PN. I have not expanded my role for money, I just enjoy my work and would get bored not using a higher level of clinical judgement. I think that unlike GPs, not all practice nurses have the same professional background, and some of us are more comfortable than others in taking a higher level of responsibility. I feel frustrated when it is assumed that nurses have to compartmentalise into 'just' asthma, or 'just' diabetes. I happily cover both these areas in addition to others, and yes, the GPs just sign the prescription as this bit they can ot keep control of (even though they do not check it most of the time)." - Linda, Greater Manchester

"I work in a very large practice, 20000 patients. The nursing staff triage all patients, not just minor illness, we manage all chronic diseaese, we prescribe from a formulary. The GPs only sign scripts. They see prebooked patient appointments only, not every day. It would be great to be financially rewarded for the extra resposibility that we have. The role of the nurse has changed immenseley and should be rewarded." - Nurse, Lincolnshire

"I love working with practice nurses, much more than I did with their hospital equivalents, and have found the vast majority excellent at what they do, so why not keep them doing what they do well? All of them have also told me that they have no desire to take on all the extra tasks that would be required of them if this kind of plan were to come to fruition." - Dr Adam Harrison, GP, Nottingham

"Sally, if the only problem you see with doing the work of a doctor is that you will receive less money for it, then you haven't thought the problem through.I wouldn't presume I was able to do the work of a nurse or anyone else who was trained in an area I wasn't, whatever I was paid for it." - Maureen, Scotland

"I'm sure that nurses could deliver 70% of primary care. The problem is going to be working out which 70%" - Bill Gibson, Sheffield

"I don't think we should or necessarily can. I work in asthma but am glad that I have developed this specialist interest. However, it has taken 15 years for me to get here and I would not be happy to branch out to diabetes etc. So let's keep our doctors and allow ourselves to help deliver quality instead of these silly suggestions." - Jo Cohen, London

"Nurses may well be able to do 70% of general practice. But which 70%? Learning which bits shouldn't be done in the community - this is exactly what give years medical school and all that postgraduate training teaches general practitioners. It's all too easy to look at someone else's role and from an ignorant and superficial appraisal feel that you could do it better" - Andrew Robinson, New Zealand

"There are better ways to tackle overspend in healthcare than getting rid of a group of highly qualified practitioners and replacing them with another group who do not have the same training or even did not come into medicine to be doctors!" - Nikkah, SE London

"Sally, if the only problem you see with doing the work of a doctor is that you will receive less money for it, then you haven't thought the problem through. I wouldn't presume I was able to do the work of a nurse or anyone else who was trained in an area I wasn't, whatever I was paid for it." - Maureen, Scotland

"Same old thing - wanting more for less!! They'll want the same/higher standard of care but for the nurses to deliver it which will save money because we earn just a fraction of the average GP's salary! Oh what a joyful prospect!" - Sally, Midlands