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Exclusive: Warning over using 'scarce' nursing staff to meet GP gap

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Relying on nurses to address the primary care staffing crisis would risk “robbing Peter to pay Paul”, a policy expert has warned. 

Dr Rebecca Rosen, senior fellow in health policy at Nuffield Trust, said directing more nurses into general practice could end up worsening already severe shortages in other areas of the health service. 

“Simply bringing more nurses into general practice immediately risks robbing Peter to pay Paul”

Rebecca Rosen

New analysis of figures by the think tank for Nursing Times shows how a steady rise in general practice nurses (GPNs) is being outstripped by soaring patient demand. 

Between September 2015 and September 2018, the number of GPNs in English practices went up from 22,758 to 23,406.

However, over the same period, the number of GPNs per 100,000 people in England dropped from 40.30 to 39.89.

The data comes after a joint BBC and Nuffield Trust investigation revealed that general practitioner (GP) numbers have fallen in a sustained way for the first time in 50 years.

A special day of coverage by the BBC on Wednesday included an episode its flagship Panorama series exploring how shortages of GPs were making it more difficult for patients to get an appointment.

The programme reported on how other health professional groups, such as pharmacists and paramedics, were being introduced to the primary care team to ease pressures on GPs. 

However, nurses subsequently criticised the programme’s coverage for overlooking the important role played by nurses in primary care. 

Approached by Nursing Times, Dr Rosen said nurses were vital to overcoming the workforce challenges in primary care. 

“Looking ahead, nurses certainly need to be part of the solution to filling the general practice staffing gap,” she said. 

“Growing numbers can now prescribe and some have trained as advanced practitioners who can work autonomously and take on much of the role of doctors in efforts to meet rising demand,” she added. 

Dr Rosen noted how action being taken to embed primary care into nurse training courses could potentially lead to more nurses choosing to enter the profession. 

Rebecca rosen 3x2

Rebecca rosen 3x2

Rebecca Rosen

But she highlighted that regard needed to be paid to the potential knock-on effect on other sectors, which were already struggling with nurse vacancies.

“General practice doesn’t currently feature heavily in nurse training, something initiatives from Health Education England are already setting out to address,” said Dr Rosen.

“In the long term it would be good to see that change build a bigger workforce committed to working in general practice,” she added.

“However, the nursing shortages in hospitals and district nursing teams are also serious, so simply bringing more into general practice immediately risks robbing Peter to pay Paul,” she said.

“Pressure on GPs is likely to affect the workload of practice nurses too”

Becks Fisher

The Health Foundation added to the conversation this week by releasing new analysis showing how GPs in the most deprived areas faced a 15% higher workload than those in well-off communities.

Dr Becks Fisher, GP and policy fellow at the think tank, stressed to Nursing Times that addressing GPN staffing issues was “just as important” as tackling GP challenges.

“The fall in GP numbers means that nurses working in primary care are an even more precious resource – and one we need to use as wisely as possible,” Dr Fisher said.

“They play a critical role,” she said. “But they’re also a scarce resource and pressure on GPs is likely to affect the workload of practice nurses too.”

Dr Fisher said the small increase in the number of GPNs “falls short” of what the Health Foundation estimated to be needed to keep pace with rising demand.

“The need to recruit and retain nurses to general practice is just as important as the need to boost GP numbers,” she added.

In March, the Health Foundation, Nuffield Trust and the King’s Fund released a joint report called Closing the Gap, which presented a fully costed proposal for addressing the NHS staffing crisis.

The report authors warned that England had no chance of training enough GPs to fill the shortages it faced and that the only way to stay afloat would be through the help of other staff and widening the multi-disciplinary team.

They recognised that nurses could make a major contribution but said they did not include them in the calculations because of the “supply constraints”.

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Readers' comments (1)

  • GPN's are carrying out at least 50% of GP's workload.
    Most of the time intensive procedures are being carried out by GPN,asthma assessment, cervical smear,contraceptive implants, INR review,Diabetes assessment. All these procedures are time consuming & GPN's are being pressurised to carry them out in 10 mins so they can see more patients & bring more money to the practice.
    Most GPN's are burnt out as much as the GP's. On top of that the salary is really awful & GPN's don't get the raise & yearly increment like NHS nurses. Lots of GP practice are using healthcare assistant to carry out BP check & other minor procedures & dressing to save money. The accountability for these tasks still falls on the GPN's. If any test or follow up is missed out.
    The patents who pay their NHS contributions deserve the best care available from the care professionals trained to do the job. There are serious issues with ratio of nurses to patient which determine if care is being delivered safely. All that doesn't apply in GP practice.
    The motto is to see as many patients as possible in the shortest possible time. All GP practices should really come under full NHS control & not work as independent self employed practitioners.

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