GP Dr John Cormack thinks more needs to be done to get the views of practice nurses heard
My practice has always been largely dependent on our practice nurses. Due to the way general practice has been managed and financed in this area during the primary care trust era, we cannot afford to employ doctors at my single-handed practice, so the fact we can hold our heads up high with regard to the various quality indicators is only because our GPNs do such a fantastic job.
However, the problem I’ve come across is that no one asks for their opinion on working practices or the changes they would make to improve the service. I often find myself at meetings pontificating on the management of type 2 diabetes or COPD and all I can do is give a very garbled version of what I think our nurses would say.
Unfortunately, as the powerhouse of my practice, the nurses cannot spend hours attending endless meetings of the sort NHS people love (the ratio of hot air to decision-making is far too unfavourable). Plus, they have to ensure that their work/life balance is healthy.
In an attempt to change all this I filmed some interviews with our nurses to feed their views back to the people who make the decisions in Essex. So far, the response has been positive. Nothing much has changed as a result, as yet, but it is very early days.
Our GPNs are broadly in agreement with each other as to the main issues. With COPD, everyone agreed that the proposed changes to the way spirometry is delivered are daft given that there is nothing much to put in the place of the capable nurses who are responsible for the diagnosis.
I know not everybody agrees with this, but in places where the nurses are doing a great job, why put up barriers when the more that can be dealt with ‘in-house’ the better? NHS care is already far too fragmented.
The recurring criticism for type 2 diabetes was the limitations placed on the specialist nurses by the formulary here in Essex. They all agreed it was to the detriment of patient care and, moreover, resulted in well-trained and experienced nurses being ‘deskilled’.
Lack of time and work pressure were major problems. Our nurses are still involved with insulin initiation but less so than before because it is time-consuming – so better funding would be a solution.
We’ll put some of their videos online, so you can see how we’re trying to get their views heard by the decision-makers.
Dr John Cormack is a single-handed GP in Essex
Click here to see a video of one of the practice nurses at Dr Cormack’s surgery
Click here for a second video