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Nurses to outnumber GPs three to one in Darzi centres

By Gareth Iacobucci

Nurses will outnumber GPs by as much as three to one in Lord Darzi's national network of polyclinics, amid moves to radically reshape the skill mix of primary care.

The Department of Health has instructed PCTs to work to a staffing blueprint of three GPs and nine nurses for the so called GP-led health centres, Pulse can reveal.

News of the move – revealed under the Freedom of Information Act – came as a leading primary care academic called for nurses to become the ‘true frontline providers of primary care'.

But GP leaders warned the proposed staffing ratio was the exact reverse of that in most GP surgeries and risked producing second-rate care for patients.

The DH proposals are outlined in a list of FAQs for PCTs tendering for GP-led health centres under the Government's Equitable Access Scheme and are based on assumptions from the 2007 comprehensive spending review.

The document recommends each centre should employ three GPs, nine nurses, one healthcare assistant and associated administrative support.

The ‘working assumptions' show nurses would also play a key role in the 113 new APMS practices to be deployed in underdoctored areas, although to a lesser extent.

Based on an estimated list size of 6,000 patients, the new practices are expected to be staffed by four GPs, three practice nurses and a healthcare assistant.

The DH insisted nurses would provide patients with at least as good care as they received from their existing GP practices, particularly in non-complex cases.

A spokesperson said: ‘Where people choose to register with a GP-led health centre, they should expect at least the same quality and continuity of care from GPs and other primary care clinicians as they would from any other GP practice.'

‘Patients, particularly those with complex or multiple conditions, will of course want to benefit as now from the continuity of care at a local GP practice.'

But Dr Chaand Nagpaul, GPC negotiator and a GP in Stanmore, said the plans amounted to ‘cut price general practice'.

‘There is no evidence that this is what patients want. We believe patients want adequate access to GPs. This case-mix, with nurses outnumbering GPs by 3:1, is unheard of in normal NHS GP surgeries.

‘This is an over-substitution of doctors with nurses, and I think it's no surprise that the private sector will bid for this lower-cost general practice.'

Professor Bonnie Sibbald, professor of health services research at the National Primary Care Research and Development Centre, called in the BMJ for the trend for nurses to take on greater responsibility to be followed ‘to its logical conclusion, acknowledging nurses to be the true frontline providers of primary care'.

She told Pulse: ‘It makes sense that GPs should use their considerable skills on the minority of patients – with complex health problems - that only they can manage.

‘There is a shift towards a higher proportion of care delivered by nurses. I know the Government supports the idea that primary care should be delivered by multi-disciplinaried teams.'

Nurses taking steps to becoming new front line providers of primary care Nurses taking steps to becoming new front line providers of primary care

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