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Utilise nurses more fully under contract

If the nurse takes on an increasing number of medical tasks the GP is left free to concentrate on the work involved in

the quality framework says Dr Dr Stephen Gardiner

For many doctors the prospect of recording and continually updating large amounts of clinical information for the purposes of quality framework points in the new GP contract will appear daunting.

The way for practices to do well lies in delegation and diversification. There are too few doctors to do all the work that is required and this is recognised with the move to practice-based contracts. Practices therefore need to ensure other members of staff are used in a cost-effective way.

In most practice the nurses will already be offering routine treatment room care and, very probably, some chronic disease management clinics. But there are other ways nurses and other non-medical staff can be utilised.

In my practice we have been developing the roles of our nurses for many years. They offer a wide range of clinics covering asthma, COPD, diabetes, contraception and HRT. We have also trained them to manage common minor illnesses and to run computer-assisted anticoagulant monitoring clinics.

They are excellent at completing the templates used for chronic disease management, and audits of their performance are embarrassingly good. They prescribe appropriately and safely and, in minor illnesses, generally less often than doctors do. Patients are highly satisfied with the services they provide and the doctors benefit from reduced pressure for appointments and from working with nurses who are professionally fulfilled.

But things can be taken further. Why not also use practice nurses to phone asthmatics at home to assess their control, and ask your local pharmacist to record their peak flow and assess their inhaler technique when collecting their prescription? These are all valid ways of recording information for the framework.

We have recently employed a nurse practitioner who is able to triage and see a wide range of patients requesting urgent appointments. We are developing protocols to allow the delegation of the care of diabetes entirely to her through the supplementary prescribing course she is completing.

Hypertension is another area in which management can be protocol driven ­ such as using the Cambridge AB/CD rules. Delegation of the care of these conditions will free up huge amounts of doctor time.

As well as utilising your practice nurses more effectively, who else in your practice can offer your patients more than they currently do? We have found receptionists and clerical staff are often keen to take on new roles. We have been able to use our local hospital's training courses, and we now have a full-time phlebotomy and ECG service using staff already familiar with the practice. The success of this move has enabled us to train receptionists to record blood pressures and offer health promotion advice to patients waiting for appointments or visiting the surgery for other reasons.

The advantages of using practice staff for new roles include cost savings, increased staff satisfaction and the release of doctor time. We are planning to use this time to offer more enhanced services within our practice, to develop our own interests and earn additional income. We could also increase the time we are able to spend with each patient.

The latter may be especially important. With the increasing number of hospital specialists who know more and more about smaller and smaller areas of medicine I foresee GPs being the new general physicians of the future.

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