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Nurse-led primary care ‘devalues GP expertise’

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Nurses should not lead primary care services, a doctor has controversially argued in the BMJ.

‘The concept of nurse-led primary care, driven by cost-cutting agendas rather than adequate evidence, devalues medical training and the complex expertise of the GP,’ argued Leicester GP Dr Rhona Knight.

‘It also undermines the importance of nurses in delivering their unique contribution to primary healthcare,’ she added.

Dr Knight cited inconsistencies in the ‘titles, training, knowledge, skills and experience’ of primary care nurses.

‘When I take my son to the nurse-led primary care out-of-hours unit with yet another rugby injury, I do not know if the emergency nurse practitioner (ENP) I meet has completed two weeks’ ENP training or a longer, more complex course,’ she wrote.

Dr Knight said nurses wanting to carry out the work of GPs should qualify as such.

But Bonnie Sibbald, professor of health services research at the University of Manchester, defended nurse-led primary care services. She said nurses were already delivering care to the same standards as GPs in most areas of general practice, including preventative health care and long-term conditions.

Doctors should tackle more complex health problems, according to Professor Sibbald. Too often, she said, GPs provided the same services as nurses, which led to service duplication.

‘UK general practitioners have already yielded considerable ground to nurses in the interests of improving the quality and efficiency of primary care,’ she wrote in the same issue of the BMJ.

‘It is time this trend moved to its logical conclusion, acknowledging nurses to be the true frontline providers
of primary care,’ she said.

Lynn Young, RCN primary care adviser, said: ‘Good nurses can liberate doctors but it is about practices making sure they have the skill-mix that is right for them and their local needs.

‘Nurses are more than capable of dealing with illness but what we would be arguing for is better use of nurses, which would in turn create a better use of GPs,’ she added.

Linda Bailey, RCN Health Visitors and Public Health Forum chairperson, added: ‘It’s not about pitting nurses against doctors – they need to be used to complement each other.’

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