Nurses have called for greater recognition of the vital role they play in general practice, amid claims their contribution was overlooked in a BBC documentary on the primary care crisis.
Last night’s episode of current affairs show Panorama – titled GPs: Why Can’t I Get an Appointment? – explored how the shortage of family doctors was making it more difficult for patients to get an appointment.
“General practice nurses are just basically phased out I think, you can’t see them”
The programme reported how other professionals such as pharmacists and paramedics were being brought in to plug gaps but did not cover the role of the general practice nurse (GPN).
Members of the nursing community took to the social media site Twitter after the latest edition of Panorama was broadcast to share their frustration.
Registered nurse Paul Vaughan wrote: “I cannot believe as I watch the Panorama programme on getting a GP appointment that there has been no discussion about the role the registered nurse makes and can make in primary care. Nursing does and can make the difference if they were invested in.”
The Royal College of Nursing’s GPN Forum highlighted that there were more than 22,900 GPNs in the workforce and stated: “Continually writing them out of general practice dialogue exacerbates crisis, as it leads the public to assume they should only see a GP. This is both outdated and erroneous!”
Meanwhile, the Twitter account of the WeGPNs digital community of practice nurses said practice nurses “continue to be invisible”.
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Ellen Nicholson, course director and module lead for general practice nursing at London South Bank University, also criticised the coverage on Twitter.
In an interview with Nursing Times, Ms Nicholson said GPNs were “phased out” of the media.
“We absolutely, as nurses, get that there’s a GP crisis just as much as there’s a nurse crisis. But when it focuses on general practitioners there’s a lack of recognition of the roles that are behind them,” she said. “General practice nurses are just basically phased out I think, you can’t see them.”
She highlighted how nurses had been part of general practice since the 1960s and now led on many areas such as immunisation and chronic disease management.
However, Ms Nicholson said this was not widely recognised and often people assumed it was GPs delivering these services.
“Because they come under the remit of the GP surgery, it tends to be the GP themselves who are recognised for providing those services rather than the nurses who are actually providing those services,” she said.
Advanced nurse practitioner Ms Nicholson said there was a need to change the language used around general practice to be more inclusive of the multi-disciplinary team.
“If the patients know that is an option they may be asking then to see their nurse practitioner”
She said: “If we continue to have that dialogue that patients go and see their GP, we are actually not helping our patients and their population health, because they have that perception in their head – ‘I need to go and see my GP’.
“Whereas in actuality, they should be seeing their nurse or their pharmacist or their physio,” she said, “I think speaking wider you need to change the whole dialogue here so there’s recognition of the whole team.”
Catherine Edmunds, an advanced nurse practitioner and practice nurse education facilitator in Waltham Forest, told Nursing Times she believed there was an opportunity to make general practice a more attractive profession if it was given better coverage in the press.
However, she said the limelight was currently focused on new roles entering the primary care team, such as physician associates.
“All the media at the moment seem to be concentrating on the new roles and not really talking about the nurses that often have a much wider, more holistic role, and an awful, awful lot of experience, and yet that doesn’t seem to be there,” Ms Edmunds said.
“If we could do more to advertise the opportunities for nurses in general practice you could get a lot more nurses moving into general practice which would really help with the workload across the board,” she added.
Ms Edmunds agreed that there needed to be a change in the language and that this could help to manage patients’ expectations.
“We did want to feature a nurse in the main practice we filmed in but none wanted to go on camera”
She highlighted how patients sometimes questioned why there were being seen by her and not a doctor, although she said that this had improved over the past five years.
“For me, as an advanced nurse practitioner, sometimes people might say ‘oh, I thought I was seeing a doctor’ when in actual fact advanced nurse practitioners have been trained to a high level.
”If the patients know that is an option they may be asking then to see their nurse practitioner rather than their GP,” said Ms Edmunds. “Likewise, someone with a knee problem might start ringing up and asking to see the physio rather than the GP.”
Crystal Oldman, chief executive of the Queen’s Nursing Institute, said general practice nursing was not visible as a profession.
In terms of community nursing, Dr Oldman noted how GPNs had not historically had the same profile as district nurses and health visitors because they had not been around as long.
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She believed the BBC had “missed an opportunity” to highlight the work of GPNs while maintaining its main message about the shortage of GPs.
In an interview with Nursing Times, Dr Oldman said she particularly resented when the media concentrated on “shiny” new roles in general practice to the erasure of GPNs.
“What is the frustration for nurses if they have been there for a very long time and what we get in the media is either it’s the GPs that are talked about, or the shiny new services – we are all going to be rescued by the paramedics coming in, or the physician associates,” she added.
“Again, that’s another time where I know I’ve been frustrated… when the shiny new solution to the problem is talked about and the nurses don’t form a part of that,” said Dr Oldman. “That’s almost more disappointing for me I think than when there is a headline about GPs.”
Julie Belton is a nurse practitioner and strategic and operational director of Cuckoo Lane Practice in west London, currently the only nurse-led practice in the UK.
Regarding the Panorama documentary, Ms Belton said: “I was shocked and disappointed to see there was no mention of nurses, and indeed of the huge contribution GPNs make to primary care. This is devaluing an already under-trodden workforce.”
She highlighted how 85% of appointments at Cuckoo Lane were delivered by nurses who had helped the practice to achieve an “outstanding” rating from the Care Quality Commission.
In addition, Ms Belton said evidence showed nurses bridged the socio-economic gap between patients and healthcare professionals as well delivering safe, high quality and effective care.
“Nurses in general practice work tirelessly alongside their colleagues - including doctors – and make up a large proportion of the general practice workforce,” Ms Belton told Nursing Times.
“They should be remembered and valued for the huge contribution they make to the provision of care in general practice,” she added.
In response to Nursing Times, the BBC said it could not find a GPN who would speak on camera.
A spokesman said: “We did want to feature a nurse in the main practice we filmed in but none wanted to go on camera, as is their right.”