Failures at a Norfolk health centre highlight the need to understand the “significant risk” of nurse-led primary care practices, according to the author of a damning report into care failings.
NHS East of England commissioned an independent report following four serious incidents, a patient death and the suspension of two GPs at Downham Market Health Centre in 2010-11. The report, published last week, found there was a “serious deficiency” of safe care and a “complete breakdown” in monitoring and accountability arrangements.
A single nurse was left fulfilling the lead management role at the practice, as well as a clinical role. This nurse then went on sick leave amid allegations of bullying “from most staff members, including GPs” and the suspension of two GPs left the practice relying on locums.
Care at the practice “may have resulted in harm” to patients, it said. “Despite the practice sliding into managerial failure, the staff held it together, going well beyond their job descriptions to ensure the provision of care to their patients.”
Both NHS Norfolk and Norfolk Community Health Care, which ran the practice until April, were criticised in the report, which said Downham Market “was allowed to slip beneath the managerial radar of both organisations”.
Former Royal College of General Practitioners chair Professor Mike Pringle, the report’s lead author, told Nursing Times the organisations should have been aware of the “significant risks” involved in nurse-led practices.
He said: “I’m not suggesting that nurse-led practices can’t work, but it is a more difficult model to make work… it requires making sure that the right structure is in place.”
Nurse-led practices needed to be led by a team of nurses, rather than an individual, and should have GPs with a “long term commitment” to the practice, rather than locums, he said.