Using nurses to triage simpler conditions is safe and will save money, argues nurse and RCGP fellow Lynn Young
Once again that most thorny and emotive of issues – skill mix within clinical teams – raises its complex head.
It is of little surprise to read that private firms are increasingly attracted to paying appropriately educated nurses to manage out-of-hours services, rather than their more expensive colleagues, GPs.
Last month Pulse reported that leading private providers were considering ‘radical' changes in staffing, with nurses and healthcare assistants increasingly used for triage, diagnosis and management of simple conditions.
Discussions relating to skill mix in healthcare are as old as healthcare itself. The UK maintains a liberal framework of practice – and this ensures that we regulate professionals, but not practice (except for prescribing, death certification and medical sick notes), allowing us to challenge existing practice when health needs change, where there are advances in technology and when we need to push the traditional boundaries in order to improve services.
Since the introduction of the NHS
Plan in England and the equivalent in Northern Ireland, Wales and Scotland, changes have been made in terms of who does what so that various targets and the European Working Time Directive could be met.
The changes have been achieved without compromising patient care. Indeed, patients have often received better and faster care as a result of different professionals working closely together. Strong teamwork has blurred traditional disciplinary boundaries.
A number of new out-of-hours services were developed after the new GMS contract in 2004, which saw significant numbers of advanced nurse practitioners taking the place of GPs.
Profession must adapt
Professional practice has to be dynamic if it is to continue to be relevant.
Not so long ago, it was unusual for a GP to employ a practice nurse. Today, 20,000 practice nurses form an essential part of modern general practice.
Practice nurses routinely carry out a range of clinical activities, which were previously the domain of the doctor.
Non-medical prescribing and masters-level nursing programmes enable nurses to manage both minor ailments and long-term conditions as well as many doctors, which in itself does not necessarily diminish the need for GPs.
But whenever changes in practice evolve, at the centre of the discussion must be the question: ‘In whose interests are we serving?' The patient always comes first, and all change must be implemented for the best and safest of reasons.
When considering cost, it is vital to remember that high-quality care means that few mistakes are made, symptoms are identified early and the right care is given at the right time.
We need to continue to operate within a liberal framework, being capable of quickly changing ‘who does what' for the key reason of meeting public need in an exemplary, but also affordable, way.
It would be wise to focus on examining the competence and knowledge of the practitioner, rather than be obsessed by title and tradition.
Lynn Young is primary healthcare adviser at the Royal College of Nursing and an honorary fellow of the RCGP
