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Exclusive: Nurse-led primary care model 'could ease GP shortage'


Nurse-led surgeries could be the solution to the GP shortage, say nurses who have established one of the first set-ups of its kind in the UK.

The Cuckoo Lane Practice in Ealing is owned and run by nurses and was recently rated “outstanding” by the Care Quality Commission, making it one of only 3% of surgeries inspected so far to get the top rating.

Nurses who work there say it could provide a model for future primary care services and help alleviate widespread shortages of GPs.

The practice, which provides services to around 4,000 people in North West London, is owned by two nurse practitioners – Julie Belton and Carol Sears – who run it under an Alternative Provider Medical Services contract.

“This is a proven model that could absolutely be delivered elsewhere and I do think it is a solution to GP shortages”

Julie Belton

It is staffed by three part-time salaried GPs, five nurse practitioners, four nurses, a healthcare assistant and a range of non-clinical staff.

Started in 2005, Cuckoo Lane is understood to be one of the first nurse-led general practices set up in the UK and the only one still operating at the moment.

Ms Belton said this kind of set-up could “absolutely” be a solution to the current GP crisis, with nurses a “massive untapped resource”.

“This is a proven model that could absolutely be delivered elsewhere and I do think it is a solution to GP shortages,” she told Nursing Times.

However, she cautioned that to be successful it needed the “right kind of leadership and organisational culture”.

“You have to have the right skillset to drive these things forward, so it is about identifying people and preparing them for leadership roles,” she said.

“We need to invest in individual nurses with potential, so when practices come up, and GPs retire, bids by appropriate nursing structures are accepted,” she said. “There is a massive untapped resource out there.”

The Cuckoo Lane model has attracted interest from NHS England, but Ms Belton was keen to stress it should in no way should be seen as a cheaper option to more traditional GP practices.

She said nurses had ways of working, values and skills – including communication skills and the ability to engage with patients – that meant they were well-suited to running primary care services.

“It’s a model that could be replicated in the future, which may well address the shortage of GPs in five or 10 years time”

Helen Ward

She added that she would like to see a national programme of investment, including in training, to help kick-start more nurse-led general practices.

In the meantime, Ms Belton revealed that she was interested in the possibility of expanding her practice in the future, as well as supporting others to develop their own.

Helen Ward, principal lecturer in non-medical prescribing at London South Bank University, works at the practice one day a week as an advanced nurse practitioner.

“I think it’s a model that could be replicated in the future, which may well address the shortage of GPs in five or 10 years time,” she told Nursing Times.

“Saying that, it has been extremely hard work for those involved in setting it up,” she said. “It has taken them a long time to get to where they are and there have been a lot of hurdles along the way.”

Ms Ward agreed that moves to establish more general practices along the same lines would require experienced nurses with the right skills.

“It’s finding the right nurses to be brave enough to take that model forward really,” she said. “You need to have sound leadership and management skills, insight into how a business is run and knowledge of how local commissioning works.

“It is not just an advanced clinical role by any means,” she noted. “It is about getting the right nurses in the right place and perhaps having more of a political agenda to support it.”

Cuckoo Lane Practice

Members of the Cuckoo Lane Practice, including its owners Carol Sears (front row, third from left) and Julie Belton (front row on right)


Readers' comments (24)

  • Great idea and one which more nurses should consider.

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  • What a fantastic achievement by nurses. I've been saying this for years:- "Nurse Practitioners, Specialist Practice Nurses and an effective skill mix CAN run General Practice.
    I am an independant Practice Nurse and can see how it could be rolled out in the UK in the near future. Is there any campaign as I would definately support it. If I wasn't close to retirement I would have considered to work with a consortium of nurses to set up as an alternative primary care provider.
    I do hope that many practice nurses in the future have the opportunity to do what you have achieved.
    Very well done indeed and best wishes.

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  • Well I most certainly do NOT want to be seen by a nurse when I am ill!!

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  • Anonymous | 21-Jul-2015 9:37 pm

    nor do I, otherwise I would just advise myself which may not always be sufficient!

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  • Oh dear, missing the point completely previous comentators. No wonder you chose to remain anonymous. I can only think that you do not understand the training nurse practitioners in general practice have and what experience and support they are given. Also you should note '1 of only 3% of general practices to be rated outstanding'. Says it all. Well done

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  • Having just completed my Advanced Nurse Practitioner qualification at Masters' level study, I have to agree with Karen that there is a lack or understanding of the training that nurses undertake. Nurses are highly qualified healthcare professionals. Well done on achieving an outstanding from CQC!

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  • This is an amazing achievement, well done. I agree with Karen's comments about the level of training these nurse practitioners undergo. Given this, I would certainly be happy to be seen by them - particularly as it has been rated outstanding!

    My only reservation is that we not only have a shortage of GPs but also nurses. However, this type of career opportunity might get more into the service.

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  • Brilliant! Nurse training is patient-facing from the start and involves management skills, as well as good general medical knowledge. Nurse specialist training adds in-depth knowledge and experience. For doctors, the practical and people skills are added in only after a great deal of academic study. Nurses' training probably fits them better to be the gateway to services, saving their doctors as a scarce resource to be utilised where needed.

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  • Sounds fantastic, what a great achievement! And one that will hopefully be replicated across the UK. I would be interested in joining (maybe in the next year or two) as a registered mental health nurse to offer my expertise!

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  • Such a pompous remark! Anonymous..
    Nurses today are being trained to a top level and can go far higher and thank goodness for that. My own GP's comment to my daughter who is just about to qualify as a Nurse - although has the grades for medicine but couldn't get in - was, "oh no, go into medicine its far more money"... My daughters response, " I thought you went into medicine because you had compassion and an interest in people and their health!!" now tell me, do you want to be seen by someone competent, well trained,informative and compassionate who gives a damn, or a "medic" who really is interested in you as a money making machine!!! Well done to you all and here's to many more!!

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