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'Significant proportion' of 'avoidable' GP appointments could be with nurse


More than a quarter of appointments with general practitioners are avoidable and in many cases patients could instead be seen by a nurse prescriber, a survey of doctors has found.

An audit of more than 5,000 GP appointments in England this year found 6% could have been carried out by another professional within the practice.

In particular, a “significant proportion” of these could have been managed by a prescribing nurse, said the report, by primary care organisations NHS Alliance and Primary Care Foundation.

“The greatest opportunity to relieve pressure on GPs is by extending and making fuller use of the wider practice team”

NHS Alliance and Primary Care Foundation report

The report – called Making Time in General Practice – looked at how GPs can be freed up to carry out work only they can do.

It was commissioned NHS England in response to the escalating workload felt in general practice being driven by an “unprecedented” rise in the number of patients, increasing complexity of conditions and “growing expectations both from politicians and policy makers”.

The report, which also noted the recruitment and training crisis among both GPs and practice nurses, was produced as part of NHS England’s ambition to create a “new deal” for general practice, announced in the NHS Five Year Foward View.

“The greatest opportunity to relieve pressure on GPs is by extending and making fuller use of the wider practice team”, said this latest report.

A more diverse range of roles such as nurse practitioners, practice pharmacists and physician assistants should be considered by general practices, said the report, which called for NHS England to offer financial incentives to create more of these and other posts, such as practice nurses.

“This report documents how general practice is struggling with an increasing workload and the urgent action required to relieve this burden”

Rick Stern

Practices should also be given more support to understand how different roles can lighten GP workload and improve care to patients, it added.

Other problems identified included poorly organised nursing care, including catheter changes, following patient discharge from hospital, and delayed discharge letters.

Rick Stern, chief executive of NHS Alliance and a director of the Primary Care Foundation, said: “This report documents how general practice is struggling with an increasing workload and the urgent action required to relieve this burden.

“We want to ensure that GPs and their colleagues in general practice are freed up to deliver the job they were trained to do and care so passionately about.”

Dr Robert Varnam, head of general practice development for NHS England, said: “General practice is the bedrock of healthcare and NHS England commissioned this report because we are determined to support GPs in reducing the pressures they face. 

“The findings include helpful suggestions which should free GPs to spend more time with patients most in need and further ways to reduce the administrative burden.”

The report comes at the same time as prime minister David Cameron has announced details of a new, voluntary contract for GPs to deliver 7-day care for all patients by 2020.

The new contract will apply to federations or practices that cover populations of at least 30,000 patients. It has been designed to encourage neighbouring practices to join forces and ensure closer working with community nurses and other healthcare professionals.


Readers' comments (5)

  • 'In many cases patients could instead be seen by a nurse prescriber.'
    Unfortunately, the government is cutting primary care remuneration, so GPs' ability to employ nurses to do this work is being curtailed.

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  • As a Practice Nurse with 34 years of nursing behind me, currently studying for a masters, my worry is that we are going to lose the Practice Nurse concept. I will be practising as an Advanced Practitioner shortly, but where is the nurse with experience to replace me going to come from? The answer is HCA's. The Practice Nurse as we know it will disappear, as all the nurses become 'experts' and 'Advanced Practitioners', to cover the short fall in GP's.

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  • i really don't know why research/surveys are carried out to reach obvious conclusions!! I have been a health care professional for 30 + years so realised 30 years ago!! Many of us come across members of the public through our family/friends etc where what they relay to us clearly does not warrant a GP appt Especially new mums and dads often merely need lots of reassurance regarding their children. Advanced practitioners with at least 3 years experience in their field is what we require in surgeries. AP specialising in Paeds, elderly care, obstetrics etc As long as GP on site to liaise/confer with After all is that not what happens on the wards we ring the doctor to say what we require for a patient or for them to sign prescription sheet that in my day we had written as often we're clinically more experienced than the SHO And of course these were patients that were unwell! Primary care surely risk is lessened Of course it is about taking ownership of the responsibility without 'signoff' by hospital doc But if one feels confident and trained to do so then its obvious this is the answer Clearly staff will need to be renummerated accordingly

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  • How do. You know these appointments are avoidable? You have no idea until the patient has been seen. I for one have no desire to be seen by a nurse.

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  • I know this comment is a little late....but......I have worked in General Practice for 26 years.
    I am expected to work as a Nurse Practitioner despite not having the qualifications to do so.
    I have asked over and over again for further training, to be sent on the Nurse Prescribers Course etc and been told,'NO' by my employers.
    I wonder how many hours I have spent waiting outside the doctors rooms, waiting to go in and get a prescription signed? Hoping that my diagnosis was correct, that I was practicing safely.
    Stating the obvious but it only takes 2-3 prescriptions to need signing before I am very behind and have several patients waiting longer than they should.
    - so, what a great and obvious idea that an experienced Nurse Practitioner can help out with the ever burgeoning demands of General Practice - BUT, PLEASE, train these nurses who will do this job - properly.
    I have spent time and effort, trying to interest anyone in the profession who would listen, that I am doing a job that I do not hold the qualifications for ( NMC, RCN, local LHB, Medicines Management Boards) and found that no one was interested or concerned.
    I have now had enough, I have handed my notice in and will the leave the job in general practice that I love as I cannot cope with the present situation.
    Funnily enough, my GPs asked me if their was anything they could say or do to change my mind about leaving......(!).

    Having exhausted myself in my efforts to do the right thing over the last 10 years and repeatedly asked these very same GPs for the appropriate training, why would they suddenly start to listen to me now when they have not listened to me over the last 10 years?
    GPs must be made to send their staff on the appropriate training, they and all the others like the NMC etc must not be allowed to turn a blind eye to this situation.

    I will now step off the soap box. Thanks for listening.

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