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Together we can improve services and fulfil our potential

Marilyn Eveleigh

Earlier and more flexible patient access to primary healthcare services is a mantra heard along the corridors of government and Primary Care Groups and Trusts. It is a laudable goal that will go some way to boost patient confidence and satisfaction with the NHS.

Nurses in primary care are expected to play their part in improving patient access. NHS Direct, the telephone support service, spearheads this new culture. Primary care walk-in centres are appearing all over the country in localities and buildings that meet the needs of their local population. And the general practice surgery is being appropriately targeted to provide GP appointments on the same day for emergencies, and within 48 hours for nonemergencies.

Nurses are the backbone of such established services. For those practice nurses employed by independent contractor GPs, the establishment of easier access requires a complete review of ways of working within the practice that scrutinises the roles of doctors and nurses. The process may not be easy or comfortable.
Such a review is set against a culture of practice nurse and doctor teams that has been evolving over the past ­
10 years, so that now 97% of nurses are employed part-time, and additional nursing hours have been created to meet the needs of the General Medical Services (GP) contract. The GP contract has increased immunisation levels, improved cytology uptake, delivered minor surgery outside hospitals, provided child health surveillance, and established management programmes for chronic diseases such as asthma and diabetes - but it means longer waits for routine GP appointments.

To meet the new challenge, new roles - and new responsibilities within old roles - are being established. Nurse practitioners, GP triage nurses, surgery telephone triage, minor illness nurses and healthcare assistants are mushrooming in surgeries all over the country. This is excellent for patients, and a real ­opportunity for nurses to fulfil their potential.

However, there is a great danger that practice teams establishing these services alone will encounter difficulties and disruptions to already pressurised lives. Nurses may be anxious about dramatically changing roles, and their GP colleagues may not appreciate the professional responsibilities surrounding such changing work practices, such as delegating to healthcare assistants. It provides excellence for those patients whose surgeries have had the foresight, time or resources to establish positive changes, but leaves many with an unequal service. This does not seem fair.

As primary care nurses we must share our successes, and also guide others on where we failed to establish easier patient access. And we need to establish that patients view the changes as an improvement for them. Over the coming issues, Nursing in Practice will bring you articles from those who have pioneered change - some small but significant, some large and easy. We encourage you to tell us of your experiences so others can share in the process. If you are contemplating change, tell us what your key challenges are for easier access. We have national contacts who can offer advice and help. Let us support one another, and more importantly, let us support our patients in getting timely and appropriate treatment and referral in primary care.

Good luck to those of you already establishing new ways of working - and an encouraging nudge to those of you who are ­contemplating making changes.