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'Powerful evidence' of growing role of specialist nurses revealed


“Powerful evidence” of the growing role of specialist nurses in the NHS has been demonstrated by figures showing the number of outpatients they treat is rising by more than 100,000 a year.

By the end of next month there will have been a 465% increase in outpatient attendances at specialist nurse clinics since 2005-06, the figures compiled for Nursing Times predict. This compares to a 39% increase in all outpatient attendances over the same period.

The data suggests the skills of specialist nurses are increasingly being recognised by the clinical colleagues who refer patients to them, at a time when many are having their roles scrutinised by trusts due to budget cuts.

Royal College of Nursing director of policy Howard Catton said: “The history of specialist roles is that, understandably, other colleagues may have been cautious about the advancement of nursing roles.

“These figures would seem to show their confidence in levels of competence among specialist nurses is rising…This is powerful evidence about [specialist nurses’] visibility.”

The data, extracted from hospital episodes statistics by analysts CHKS, shows outpatient attendances at specialist nurse clinics are growing by 107,002 a year on average.

The figures demonstrate that not only GPs but also consultants are increasingly likely to refer patients to specialist nurses.

In 2005-6, specialist nurses saw 236,938 attendances following a consultant referral. This was similar to the numbers seen by the most common medically staffed outpatients services – trauma and orthopaedics outpatients services (218,620) and cardiology (198,868).

However, by the end of 2010-11, attendances at specialist nurse clinics are forecast to have risen to 650,088 – a jump of 14% in 12 months – but only 428,138 in trauma and orthopaedic services and 249,747 at cardiologists’ clinics.

Meanwhile, attendances at outpatients services staffed by allied health professionals and midwives have also risen rapidly since 2005-6. But they are predicted to fall this year, unlike those overseen by specialist nurses.

CHKS has based the figures for the final five months of 2010-11 on averages from the first seven months to gain a produce a complete picture for the year. This is possible to do accurately because outpatients appointments are not significantly affected by seasonal pressures.

Independent nurse consultant Susan Oliver said specialist nurses were now playing a much bigger role in helping to manage long term conditions, such as rheumatoid arthritis, and ordering diagnostics like X rays.

However, she cautioned that there needed to be a clear rationale for using nurse specialists, rather than using them as a “drop box” when consultants could not be found. This “fails to empower the patient” and does not make the most of nurses’ “added value”, she said.

The figures also predict that 14% of patients referred to specialist nurses in 2010-11 will have needed to be referred onto somewhere else afterwards.

Royal College of Surgeons president John Black claimed this showed specialist nurses were often ill-equipped to deal with the patients referred to them.

He said: “It opens up a very wide debate about employing people who aren’t doctors to do medical work. In many areas the risk is that all it does is waste time and money… The consultant delivered service is best.”

But Mr Catton refuted this and said nurses may need to refer patients to another service such as a physiotherapist.

CHKS head of market intelligence Paul Robinson added that some of the referrals on could be caused by the poor quality of referral letters.

He said: “If [a patients’ condition] seems very simple on the letter but the nurse sees [during an appointment] that it’s more complicated they might have to refer on.”

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Readers' comments (6)

  • So, 86% don't need to be referred on? That sounds pretty decent to me. Who also says that 'referring on' is a bad thing, it still takes skill and diagnostic acumen to send to the right person.......

    What is the 'refer on' rate from medics?... Come on Mr Black get with the programme.

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  • Exactly anon 10:24 am. One statement I do agree with though, is that “It opens up a very wide debate about employing people who aren’t doctors to do medical work", although I suspect it is for very different reasons than Mr. Black has tried to argue. The fact is there is a large amount of clinical research that shows that Specialist Nurses in particular, and Nurses in general, can give medical care at least as well if not better than a Physician. This is only going to become more obvious and more common place.

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  • it could be argued that care not given by a physician cannot be defined as medical care.

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  • Anonymous | 29-Mar-2011 9:02 pm: hmm, it could, but if you take that argument further, what is the care given by Nurses when it is the same as a physician would give (ie prescribing or a specific skill)? what is paramedic care? What is the care given by military medics on the battlefield? Semantics, semantics, semantics ...

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  • Quote:"Royal College of Surgeons president John Black claimed this showed specialist nurses were often ill-equipped to deal with the patients referred to them"

    Typical arrogant and ignorant comment! I am a specialist nurse. I don't refer patients on because I am "ill-equipped" to deal with them, but because in my professional opinion they need to see another specialist or therapist to help with a specific symptom or particular aspect of their condition. None of us can work in isolation when managing a patient with a long term chronic condition. We treat the patient holistically, where a multi-disciplinary approach is essential. The reason that we do most of the referring is that the Consultants/GP's either haven't identified a problem, don't have the time to refer themselves or simply can't be bothered. As a Nurse Specialist I spend longer with the patient and we will often discuss symptoms they have never had the opportunity to discuss with the Consultant or GP.
    So, Mr Black, I suggest you spend some time finding out what we really do before passing judgement!

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  • Well, I have been referred to a specialist, who did not want me to have treatment, I had to complaint to the commission, and my G.P. interceded for me applying patients constitution. The treatment still on, the strong treatment has caused me severe eczema, and she refused to refer me to a dermatologist. I made a complaint saying I was sick of her to PALs, to Imperial College. The specialist nurse, has power, and uses it against those patients, who she believe they don't deserve/ don't like them. She can ignore/modify figures, without a fully understanding of patients' illness. My case is tragic. I am not sure how to deal with it. Please Help! No more specialist nurses.

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