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GP patients should be seen by practice nurse, says RCN

Practice nurses should be the first port of call for the majority of primary care patients, according to the Royal College of Nursing in Scotland.

The first ever national general practice week in Scotland is currently under way, organised by the Scottish branches of the British Medical Association and the Royal College of GPs.

RCN Scotland said the event should be used as an opportunity to find new ways of ensuring expanding communities have access to appropriately qualified healthcare professionals.

RCN Scotland director Theresa Fyffe said: “Everyone, regardless of where they live, should be able to quickly gain the health advice and treatment they need.

“Since 2004, the vast majority of GP practices have opted out of providing out of hours services. As a result flexible solutions to offering healthcare services have been found in many areas of Scotland. Highly qualified and skilled nurse practitioners have met this challenge and offer appropriate care and treatment to patients.

She said: “If nurses can provide these services in the out of hours period, they can also provide the same level of high quality care during the day.

“So long as patients are treated by healthcare professionals with the right skills and qualifications, their job titles are not important,” added Ms Fyffe.  

The national general practice week, themed “celebrating the best of NHS general practice” aims to raise awareness of the range of services provided locally to patients by GPs and the wider primary healthcare team, and also to encourage politicians to value NHS general practice.

Readers' comments (17)

  • OR ........ maybe there aren't enough GP's to properly run the out of hours services (since they were allowed to opt out of this) so we will have overworked nurse practitioners assessing patients over the telephone, without any medical records for the patient, with hardly any medical support.
    Or - I'll tell you what, we could bring in doctors from other countries that don’t speak English very well and have no idea how the NHS runs .......
    Oh no - I forget - nurses would be cheaper ! Oh ..Oh (excitement) -- we could get them to replace GP's during the day too! As long as we make them responsible for their own actions and accountable to the NMC - they could do it all at hardly any extra pay.

    Or am I just old and cynical?

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  • Hear hear for the above comment!!! who actually benefits from this ludicrous system?? certainly not the patients or the nurses! what a surprise its so popular- who actually gives a toss about the patient, who deserves better than a non-medical professional assessing and treating them, and the overworked unsupported nurse who may well be very qualified but is still regarded and paid as a nurse if it means saving a few bob.. not for me thanks

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  • If I go to the GP practice I expect to be seen by a GP after all aren't they trained in the diagnosis and treatment of patients, Isn't this their role.
    I would be happy to see the practise nurse for follow up care.
    The use of practice nurses is one way of acheiving the target of a patient being seeing a professional with in 48 hrs. Rather than having to wait 5 or 6 days to see the duty Dr. Don't mention the wait to see a specific GP.
    Unfortunately it can also delay a patient from receiving immediate care from a GP as one has to rebook an appointment after seeing the nurse and being told they needed to see the GP

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  • Once again the RCN showing just how out of touch with reality they really are.

    has theresa ffyfe ever done any nursing....probably back in the dark ages.

    Nurse practitioners are just medics on the cheap. They are mugs for taking the role up. Paid a pittance in comparison to the GP's they work along side.

    A GP friend of mine once said that he absolutely loved his nurse practitioner as he saved so much money by employing her (instead of a partner) and that she did the job of a GP for half the price.

    You can flower it up all you like.....more patient choice..blah...expanding roles..blah. Bottom line is it's a cheap option to a GP.

    using a practice nurse as first point of contact is unethical and bad practice. ..and very unfair on a tho innit!

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  • oh dear touble brewing

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  • I am a practice nurse with 15 years of continuous study, not in medicine, but in areas of nursing I wanted to develop. I am not a NP and don't want to work like a GP.

    However, I do seem t get an increasing amount of patients who are coming to me for a diagnosis because they feel the GP has let them down or has not kept up with the training. I also have a large number of patients saying they wish they had seen me first because I hit the nail on the head with some symptoms that had been fobbed off for years.

    It is time GPs and nurses recognised each other skills and that nurses are not always nurses because they could not qualify to be a doctor.

    It is time as people, we recognise that people have different ways of thinking and that high level academic acheivement does not always go hand in hand with lateral thinking and seeing outside the box.

    It is time that after years of practice and studying... that experience does not always mean better. It was Florence Nightingale that said something to the effect of experience can have a way of perpetuating bad habits so perhaps an up to date and highly motivetd nurse who has done years of specialist modules, could be more knowedgable in some areas than a staid elderly GP a few years away from retiring.

    Well I am a nurse a few years away from retiring, but unlike my staid employers I am chafing at the bit to know more... and more...and more... and have the ability to use it!

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  • I am delighted that the arguement here so far, does not seem to be about nurses' skill to do the job. That is a relief. However, I take issues with the statement by Anonymous | 15-Feb-2010 5:52 pm that ''using a practice nurse as first point of contact is unethical and bad practice. ..and very unfair on a tho innit! ''. I wonder where that came from. I also wonder whether the statement would apply if a patient chose to see a nurse practitioner instead of a medical doctor. And it has been known to happen. Such a contrast with an earlier statement ''A GP friend of mine once said that he absolutely loved his nurse practitioner as he saved so much money by employing her (instead of a partner) and that she did the job of a GP for half the price''. This statement suggests that the G.P has confiedence in the nurse's skills. I feel this should be our main concern presently. It would be unfair to the patients to let loose inadequately trained nurses on them. Thank Goodness this is not the case.

    If I were an employer, I would like to see my employee's abilities before I consider appropriate remuneration. Or taken the other way round, I would like my employer to see how good I am, and use that as a stepping stone for bergaining a pay rise. Or I would like to make myself hard to replace.

    I think as nurses we should embrace these roles because they can only make us harder to replace. These roles bring us ever closer to ultimately deciding how much we are paid. The doctors have managed to do that for themselves (near indispensable) by taking on responsibilities. We can certainly learn from them in that area.

    In my opinion, these new roles will narrow the pay gap between doctors and nurses by either reducing the doctors' pay, or increasing the nurses'. I suspect the latter is more likely, and probably more welcome by nurses.

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    The RCN is totally out of it's mind! Practice Nurses provide excellent specialist chronic disease management along with travel vaccinations, contraception etc.. Some have qualified as NP's so deal with minor illness and injury. Other such as Advanced Clinicians in General Practice deal in First contact, using extended knowledge backed up with extensive academic qualifications, they diagnose and prescribe and are not stupid enough to take on the OOH problem now being in debate by politicians. Come on RCN get a grip and make ure you know your nursing members!

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  • Please Please RCN - get your roles defined - this article just about summs it up!

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  • I'm not a nurse, but why not replace GP's with google?

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  • Good comment from the person above, it's cheap and would save the NHS a fortune!!! Google and nurses are the way forward. Perhaps a vending machine for the pills?

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  • I am a nurse practitioner in primary care and have worked with some great GP's and locums as well as some shoddy ones!
    Shouldn't nurse pratitioners and practice nurses augment the GP service and not replace it?

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  • I have been a Practice nurse for 10yrs and work alongside excellent GP's. I also work in OOH's as a triage nurse.
    I understand other nurses concerns about working in extended roles. I feel that any nurse can work to any extent as long as they do so within their sphere of practice.
    As a minor illness nurse/or nurse practitioner you take on the role with the understanding that you are working in an extended role and you are NOT a GP.
    I am working towards an extended role myself and understand the potential pitfalls. I think some of my colleagues need to think about what they are saying as this is the way forward like it or not ....

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  • Charlotte Peters Rock

    In my experience, practice nurses - not being trained to GP level, are also not reliable in what they say, in resepct of medical as opposed to nursing matters.

    It is a different mindset of person which goes in for each profession.

    Common sense, coupled with full medical training, is still in a position to let patients down in some circumstances.
    There is also the aspect that the term 'patient' does not signify 'unlimited patience'.

    The trail from nurse to doctor, for something relatively minor - but medical - could foreseeably take several days, since if this system does come into operation, there will still not be 'availability of appointments with a GP, as there will be fewer GPs in the practice.

    The whole idea of visiting a medical practitioner is that the patient needs to get better, now.. not to be lost in some labarynthine system from which there is no release.

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  • Great debate! Nurses are not doctors and neither is replaceable by the other, full stop.

    Completely different training and approach, not to mention the scope, depth and extent of knowledge.
    I would be wondering about the motives of someone who thought that they could confidently replace a doctor whatever the context.
    Benner described a model of skills acquisition where there are 4 stages, the first is unconscious incompetence, ie. you don't know what you don't know, or ignorance is bliss! Usually spouted in frustrations and thinking you could do it with hands tied benhind back and blindfolded!
    You move to the second stage of conscious incompetence when your present level of knowledge and skill is tested by doing something different, eg. learning a new skill. This is the stage in my experience where sitting shadowing a GP and them explaining the indepth info regarding how they got to the diagnosis or treatment conclusion they did has blown me out the water time and time again.
    I think as nurses we often specialise in one area and know what we know, and forget that moving outside of that comfort zone is another world and very uncomfortable, hence we stick to the areas we know and what gives us confidence, job satisfaction etc.
    What the nurse practitioners and AP's are really good at is assessing thoroughly and knowing when a referral is needed including to a GP.
    I think we have to be really clear and honest about what our limits are in terms of knowledge, skill and training, and what our professional boundaries are. We also need to consider very carefully what the current direction of travel is in this climate and know our worth in that. There's a lot of simplified, territory-tresspassing talk going on which I think needs challenging and reframing in reality. I would much rather be working in a team than on a battle field

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  • I agree with the general consensus that none of this is about the patient once again its about money and targets.I am waiting to sart work as an advanced practitioner but will not be a substitute for a GP and my employers are aware of this.However I have done lots of training and would like my salary to reflect this.Practice nursing is no longer the great job it once was when we all left the NHS for better pay, funded training and terms and conditions. I am under no illusion that we are being used as the cheap alternative and my place of work has acknowledged this.Now I also read that all nurses are to have degrees I remember years ago when our trining was altered to universities to give us professional recognition but that has never happened compared to other professionals with degrees.If the RCN and NMC encourage all these changes then they should be fighting for a system where oour CPD and hard work gets its financial reward.

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  • teamwork as previously mentioned is the key to good patient care. patients should know who they need to see to provide the service they need. the debate around renumeration for nurses will not be resolved until health boards stipulate rates of pay when they commision services from gp's for their staff or re-employ practice nurses and lease services to gp's.

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