Should nurses be the frontline providers of primary care, taking the place of general practitioners as the first point of patient contact? Two experts debate the issue on bmj.com.
Nurses can deliver as high quality care as general practitioners in most areas of general practice including preventive health care, the management of long term conditions, and first contact care for people with minor illness, writes Bonnie Sibbald, Professor of health services research at the National Primary Care Research and Development Centre, University of Manchester.
She argues that substituting nurses for doctors has the potential to improve the efficiency of primary health care. Too often GPs provide the same services as nurses and this leads to duplication rather than substitution of care. In fact, she says, GPs skills would be better used to tackle more complex health problems which have a higher degree of uncertainty about their diagnosis and treatment.
According to Sibbald, general practices in the UK are already aware of the value of nurses to improve the scope and quality of primary care. Over the last twenty years, there has been a rapid expansion in the numbers of practice nurses recruited to meet new service contracts. For instance, nurses now provide immunisations, vaccinations, and cervical screening services and will be a key part of meeting the quality of care targets for people with long term conditions set out in the General Medical Services contract of 2004.
She believes that recent changes to legislation, such as the right for qualified nurses to prescribe licensed medicines, have begun to allow nurses to realise their full potential. This trend, she concludes, must be followed "to its logical conclusion, acknowledging nurses to be the true frontline providers of primary care"& [while the] "general practitioners' role should evolve to become that of a consultant in primary care receiving referrals from nurses".