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Nurses accused of professional protectionism


The chairman of the Royal College of General Practitioners has criticised nurses for ‘professional protectionism’, saying they are undermining the development of a new type of medic.

Steve Field told Nursing Times he was disappointed that only a small number of training positions for assistant physicians have been commissioned. He said nurses had been unsupportive of the new post because they believed they could do it themselves.

Training for physician assistants – who undertake a two year post-graduate degree and do roles similar to junior doctors but under strict guidelines and protocols – was introduced three years ago. The first cohort are due to graduate in January.

Physician assistants are viewed by some hospitals as a solution to the reduction in junior doctors’ working hours following the introduction of the European working time directive.

Professor Field also wants the assistants used in primary care where they could take on more of the routine patient care, allowing GPs to have longer consultations with individual patients.

He said: “Nurses have not been generally supportive of this new role because many nurses believe nurses can do this role so why do we need a new work force? The roles aren’t being commissioned from the medical schools. My hunch is it’s a lot about professional protectionism.”

The GP leader called for a “big honest debate” about the skills needed in primary care. “[Nurses] haven’t been looking creatively about how we can deliver primary care. It’s more about not being creative than actually blocking.

“We need a really focused urgent look about what we need in primary care and what the work force should be.”

Queen’s Nursing Institute director Rosemary Cook said she would be surprised if there was any “organised opposition” to physician assistants. But she said there was “concern” that “we try to bring a new role in to solve every problem rather than change the way we work.”

But Ms Cook said there was already a “very large number” of nurse practitioners and skilled practice nurses working in GP practices which made it “difficult to see who does what role and what’s the role there for physician assistants”.

Assistant physician training places are commissioned by strategic health authorities. Ms Cook said that rather than wait for SHAs, individual GP practices that wanted to use assistant physicians should “spot purchase” their own training direct from universities.

Royal College of Nursing policy adviser Stuart Abrahams denied Professor Field’s charge. “Nurses have been at the forefront of developing new roles [but] it is vital to ensure that appropriate arrangements for education, training, support, supervision, accountability and delegation are in place. These are issues of safety and quality not professional protectionism,” he said.

One senior doctor told Nursing Times part of the attraction of employing assistant practitioners was that the role was relatively tightly defined around general clinical and medical duties and would have a limited career path. The source said this contrasted with nursing, which had an ever-extending career ladder into more specialised duties, higher pay and managerial responsibilities.

Ms Cook said she could see why some might see that as a problem but she questioned whether it was good employment practice to “employ people with a cul-de-sac career so they don’t leave you.”

NHS Institute productive ward programme associate Lizzie Cunningham agreed. She said: “If you curtail [people] they will leave. Intelligent people want to progress their careers. They won’t want to stay.”

St George’s NHS trust in London is planning to introduce assistant physicians – as well as surgical care practitioners - to fill the gap created in its junior doctor staffing levels.

A recent planning paper from the trust states: “The value of these roles is created through the increased likelihood for longevity in post, being able to use their local knowledge and experience to provide high standards of care to patients.”

But trust transformation work stream lead Matthew Barker, himself a former nurse, told Nursing Times that the “longevity in post” was in contrast to junior doctors, not specialist nurses.


Readers' comments (6)

  • I believe the phrase I am looking for is 'pot calling the kettle black' - professional protectionism thats a hoot, what on earth do GPs and Drs do then if it isn't professional protectionism. The remark that nurses haven’t been looking creatively about how primary care can be delivered is offensive, particuarly when many colleagues have been blocked or ignored when attempting to attend PBC meetings - where they may have been able to share their ideas and strategies.

    I am coming to the end of my nurse practitioner degree and would not wish to work as a physicains assistant, the care I deliver will I supect be more autonomous and patient centred than the above ring fenced role.

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  • I am sure thath stephen field , like many medics, likes the physician assistant role as they have control over the post, unlike advanced nurse practitioners (ANP)who work autonomously. Also can these physcisina assistants prescribe now? it was my understaning they still need to get a medic to do prescription.

    there is more than enough work for everyone. Anps do need to get their role registered as this would help in th econfusion of all new titles. Asisstant practioners, as called in the article, work in in my area are paid as Band 4 (?? th eold SEN equivalent?).
    In GP land skill mix is good idea with experienced GP seen as the consultant for complex cases, having longer time for consulation. Usind ANPs, physicain assistants, practice nurses, nurse practitioners Health care assistants, assiatant practitionersetc to see less complex cases. of course need bigger surgeris with more consulting roomse

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  • I agree entirely with Ellen's arguement that it is offensive to accuse nurses of professional protectionism when the accusers do not have the moral strenght to do so. This is in the sense that 'medical practitioners' are experts in professional protectionism, and blatantly so at that. God help the physicain assistants who are entering this cul-de-sac carrier path. Unless of course they see it as a short cut to a medical degree.

    On a different note, the posting by the anonymous authour may be percieved as somewhat effrontery, albeit inadvertently. In the second paragraph, one gets the impression that ANPs and Nurse Practitioners are not able to look after complex cases and are best advised to have experienced GPs handle such cases. How about experienced ANPs and Nurse Practitioners? The licence to practice as ANP or Nurse Practitioner is given after a post graduate qualification preceeded by some years of experience. And their roles sometimes over-lap with those of their medical colleagues, but the difference is seen in the approach. The nursing approach to patient care is one of the distinguishing features of nursing practice. No other professional cares for patients like the nurses. Nurses are not assistants to medical practitioners, unless the individual nurse wants to be.

    In addition, it my understanding that the ANP is a registerable qualification with the NMC, and all ANPs with the qualification are registered. However, I have read of nurses assuming the role by virtue of years of experience without the pre-requisite academic qualification. In such cases they are not registered with the NMC as ANP.

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  • The nursing approach to patient care is one of the distinguishing features of nursing practice. No other professional cares for patients like the nurses.

    Where did you dream that up? Care to justify that with some evidence? Seems like a bit of unjustifiable professional protectionism too me.

    If you fancy being a doctor why not try 4 - 5 years at medical school instead of being a government stooge. The RCN and NMC are a million miles away from having any meaningful register for advanced practitioners. Who is regulating and more importantly mentoring these plastic doctors?

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  • lets be honest,when they introduce hca level 4...we're gonna pay for their mistakes, pa's hca 4 does anybody see a pattern..? do they have a professional body? two year course? what the hell does the mean? doctors assistants? can you imagine the..thats not my jobness! and you're the nurse..please do we need anymore of the only difference is "you do drug rounds and I can't"????

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  • I am a practice nurse and struggling to work to the level I am trained because of the professional protectionism of my GP employer. I feel competent to do a lot more of the GP consultations so what use would another health professional be between the GP and myself when I am already struggling to convince the GPs I can do more?

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