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'Practice nurses need to be heard if primary care evolution is to succeed'

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Nursing in primary care doesn’t always get the attention it deserves, despite the huge importance of the work of practice nurses. From vaccination to managing long-term conditions, they are at the core of services that are crucial to so many patients.

However, the voice of primary care still tends to be dominated by GPs, mainly because the structure of sector has changed little since before the start of the NHS.

Practices are largely small businesses run by self-employed GP partners, in contrast to most of the rest of the NHS; practice nurses are employed by the practice, often working in isolation, in very small teams or with support from healthcare assistants. This has maintained the hierarchical relationship between doctors and nurses that has largely disappeared in secondary care.

The professional structure of primary care has helped influence public perception and reinforce outdated views. For example, patients seem to get worked up about whether they see a nurse or a doctor in primary care, but less so in other settings. The unhelpful myth that you are somehow being short-changed if you don’t see a GP has lingered.

Also, nurses working in primary care settings perhaps do not get the same level of representation as those in other sectors.

That is not to say, there aren’t excellent forums and groups focused on primary care within other nursing organisations. But it does feel like the British Medical Association’s GP committee and the Royal College of GPs are the only voices heard on primary care policy.

But in the wake of an episode of the BBC current affairs programme Panorama last week nurses have called for greater recognition of the vital role they play in general practice.

The episode, 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.

It reported how other professionals such as pharmacists and paramedics were being brought in to plug gaps, but nurses were not included. Members of the nursing community understandably took to social media to complain that their contribution had been overlooked.

On the back of the programme, Nursing Times contacted the Nuffield Trust, which had provided the BBC with data for its coverage. As a result, the think tank worked with us on an exclusive story showing how a steady rise in general practice nurses was being outstripped by soaring patient demand.

Between September 2015 and September 2018, the number of nurses in English practices went up from 22,758 to 23,406. However, over the same period, the number of practice nurses per 100,000 people in England dropped from 40.30 to 39.89.

So, there are more nurses in primary care but they are trying to look after even more patients, while the number of GPs is falling. Thus, nurses are taking on more responsibilities that used to be the exclusive domain of GPs, but without the recognition they deserve.

Of course, primary care is not just a series of GP-led services. It is increasingly a partnership between a range of professions, especially in larger surgeries and health centres.

But the simple message is that nurses working in primary care must deserve more recognition for their work than they receive at present. And if the primary care sector is to meet changing patient needs they must also be given greater influence over how services evolve.

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