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At the heart of general practice since 1960

Sorry, but a nurse won't do

Phil has a message for those of his colleagues who ask nurses to take GP appointments.

Phil has a message for those of his colleagues who ask nurses to take GP appointments.


I used to do all my own painting and decorating. Twenty years ago, I'd come home from a rough hospital shift and at the behest of my new wife I'd be up a stepladder and wallpapering or painting like a bastard. Belatedly (and I'm ashamed at how long it took me to catch on) I realised every time I finished decorating a house to my wife's satisfaction, she'd buy another one and I'd have to start over.

Now I'm older and wiser and I'll never touch a paintbrush again, so we have a Man who comes and does it. He's ideal. He's slow and inefficient, excessively talkative, and prone to not turning up or unexpectedly going abroad for months. I love him. At this rate, I'll never have to move house again.

However, he has one fault – he cadges prescriptions. He's not my patient. I know I shouldn't prescribe anything for him, but I'm a soft get. It's never for anything major, and he tells me it's a lot easier than negotiating with his GP.

He asked me if I would give him a prescription for Dovonex for his psoriasis. ‘I didn't know you had psoriasis,' I told him. ‘Yes, I have! Look at this!' I then suffered the nightmare of seeing my handyman shuffling across the floor towards me with his dungarees round his ankles. Turns out he'd developed this rash in his groin and tried to see his GP, but could only get an appointment with the nurse practitioner. She had a look, told him he had psoriasis, and gave him Dovonex.

So I had a look and it was very obviously tinea and absolutely not even slightly resembling psoriasis. He'd been applying Dovonex twice a day, not questioning the diagnosis or apparently wondering why it wasn't getting any better. I gave him the right treatment and the rash disappeared. But he's got psoriasis on his medical record and Dovonex on repeat prescription, all because of one consultation with a dumb bugger who did not even arrange any follow-up to see if her treatment would work.

I've had a go at most people in this column – NHS Direct, walk-in centres, Darzi. But not GPs, because GPs are sensible and good and wise and noble and disinterested. Except for the odd one, and it's you, yes you, buggerlugs, that I'm addressing now, so listen up. Don't do that thing where you can't book appointments in advance. Don't make your patients phone up at 8.30 on the day to get an appointment, then tell them at 8.45 they're all gone and to phone up tomorrow. That's just shite. Sort it out.

Then, don't tell them they can only have an appointment with the nurse practitioner and that the nurse practitioner can do everything a GP can do. That's utter bollocks. My handyman was told this shocking lie, and so, even, was our registrar. GP training is rigorous and intensive and I've spent years helping junior doctors get the experience and knowledge to pass these gruelling exams. It's not easy. A three-month conversion course isn't enough.

My fellow minority of GPs, would you please stop employing nurse practitioners to see patients in this manner. They are not trained or experienced enough to make these diagnoses, you're cheapening general practice, putting patients at risk, and paving the way for dangerous deprofessionalisation, so cut it out! Or I'll come round and gut yer.

Dr Phil Peverley is a GP in Sunderland.

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