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Want to improve patient access? Then empower the nursing role

Marilyn Eveleigh
Consultant Editor
In primary care, in a primary care trust near you, is a primary care access facilitator. Perhaps they have visited the practice you work with? They consider the way practices are organised and make suggestions to enable patient access to a primary healthcare professional within 24 hours, and access to a doctor within 48 hours. Figures are reported back to the Department of Health every month - they are the primary care equivalent of hospital waiting list targets!

To the voting public, the government is promising quicker access and more timely intervention, and it wants to develop a one-stop shop so that many healthcare needs can be managed within the same consultation. This means that the healthcare professional has to have a widening knowledge base, be well updated and confident in referral pathways.

Making a patient consultation more effective by acknowledging their physical, mental, emotional and social needs with a good dash of patient empowerment and health promotion is key to improving access for all. It is within the scope of the nursing role; it always has been - it is called holistic care.

For those of us working as practice nurses, within walk-in centres and other first-contact roles, the need to be knowledgeable has never been so great. First contact means you are the first healthcare professional the patient consults, and as such you need improved skills at preparing for the vast array of queries and worries that patients present with. These patients have not been filtered before they reach you - you become the filter. You filter out the issues, highlight the priorities, provide treatment, signpost on to further or more suitable action by the patient, or make a referral onto an appropriate service or support. The buzzword for this is triage.

Often we are totally unprepared for what the population ask of us - school nurses can be asked about the progression of Alzheimer's disease, just as practice nurses can be asked about getting a toddler to sleep at night; health visitors can be asked about pain management in terminal care, while district nurses can be asked about vaginal blood loss. Many nurses have experienced the privilege of having a patient's faith in our professional role and judgement - and yet felt overwhelmed at the responsibility of being the first contact. And the dialogue may not even be in a formal professional consultation - how often do family members, friends or acquaintances tap into your professional expertise?

Multidisciplinary learning, breaking down territorial professional boundaries, and participating in teamwork that challenges inefficient processes are opportunities for new and better ways of working. Sharing professional and clinical perspectives highlights wider options to meet patients' needs.

Browsing through issues of NiP, the articles lend themselves to this approach. They have a broad healthcare base - sound baseline knowledge on a wide range of clinical issues, practical points that can be applied to your practice along with professional and patient support contacts. To illustrate the point, everything from insect repellents to SARS can be found in this issue!

In addition, NiP Events - conferences and exhibitions (which are free!) - in the autumn and winter will support the wide diversity of primary care practice. Put the dates in your diary - you deserve some time out of practice for your professional development! It will benefit the patient in the end.