Nurses should replace GPs as the frontline providers of primary care, a health academic has argued, as this would improve the efficiency of general practice.
Bonnie Sibbald, Professor of Health Services Research at the University of Manchester, says nurses should replace GPs as the first point of patient contact in an article on bmj.com today.
She argues that nurses can deliver as high-quality care as GPs in most areas of general practice, including preventive healthcare, the management of long-term conditions, and first contact care for people with minor illness.
Too often, Professor Sibbald says, GPs provide the same services as nurses, and this leads to duplication rather than substitution of care.
She believes GPs' skills would be better used to tackle more complex health problems, which have a higher degree of uncertainty about their diagnosis and treatment.
Professor Sibbald writes that, over the last 20 years, there has been a rapid expansion in the numbers of practice nurses recruited to meet new service contracts. Nurses now provide immunisations, vaccinations, and cervical screening services, and will be a key part of meeting the quality of care targets for people with long-term conditions.
She believes that recent changes to legislation, such as the right for qualified nurses to prescribe licensed medicines, have begun to allow nurses to realise their full potential.
This trend, she concludes, must be followed "to its logical conclusion, acknowledging nurses to be the true frontline providers of primary care", while the GP's role "should evolve to become that of a consultant in primary care, receiving referrals from nurses."
However, Dr Rhona Knight, a GP from Leicester who has first-hand experience in a nurse-led practice, argues that nurse-led primary care would restrict patient choice and undermine the importance of nurses' unique contribution to primary healthcare.
She acknowledges that patients report a high level of satisfaction with nurse consultations, but points to evidence that patients prefer to consult with a GP if they think their symptoms are serious.
Dr Knight points out that GPs' training takes 10 years and that they are hugely experienced in dealing with undifferentiated illness, which enables them to be key deliverers and leaders of generalist healthcare.
In contrast, she says, advanced nurse training is less developed and recommends a minimum of only 500 indirect or direct supervised hours and the competencies cover "just nine pages".
Currently, she says, a lack of nationally agreed standards means that nurses have varied roles with inconsistent training, knowledge, experience and titles.
Nurses would need increased training and a similar curriculum to GPs to be able to take the lead in dealing with all illnesses, she argues. One solution could be for nurses to take a graduate health science medical course and train to be a GP and be appropriately rewarded for this role, she concludes.
Your comments: (Terms and conditions apply)
"I agree with Dr Knight's statement about patients wanting to see a GP regarding a serious matter – however, we are talking about minor illness/ailments (as stated quite clearly). I think that it makes perfect sense for nurses to have the tools to treat minor ailments, as long as it is supported by a robust follow-up/referral to GP system" – Katie Power, address withheld