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Why I am wary of the aggressive takeovers by the 'super-nurses'

A recent report on a Government conference for PCT managers 'encouraging nurses to be more aggressive in taking over practices and challenging GPs' power base' is disappointing, to say the least.

It goes against current evidence too.

What is needed is a good look at the lessons learned from both successful projects and from those many that have failed in the last five years and from those in current serious difficulties. This aggression, GPs' perception of loss of influence without loss of responsibility, and worries about clinical safety have been the main reasons for their demise.

What we need is collaborative working not power struggles. The majority of nurses are not interested in power games, but rather the more responsibility they take the more support is needed.

We may be challenging many years of hard work in establishing doctor-nurse partnerships and good simbiotic relationships, with little evidence that an alternative works better.

These nurses need to remember that with power comes responsibility. More often than not the power is taken but the responsibility shunned. This results in a disasterous working relationship with medical employees.

Nurses taking on this role need to have robust performance management procedures in place. These should transcend any relationship problems for the sake of the practice and patients alike.

Decisions based on misunderstanding of risk or where risk is not understood by nurse employer and shared with doctor employees will only damage working relationships.

According to GMC guidelines, doctors always have a responsibility to ensure patient safety, whether self -employed or employed. It is possible for 'aggressive nurse employers' to abuse their powers, exploit their GP employees or even become 'loose cannons'. As these scenarios have all happened in real life, aggressive nurse takeovers in primary care should be viewed with care.

As some doctors who have worked in such practices described their experiences as similar to George Orwell's Animal Farm, who is going to monitor and supervise these new super-nurse positions? Will nurses have to jump through hoops of appraisal and revalidation too?

Nurses' empire building becomes unacceptable to all when it thrives at the expense of patient safety and increased doctor vulnerability.

Dr Joe Zammit-Maempel

Mickleover, Derby

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