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Practice and district nurse roles should be merged, says RCGP

GP leaders are pushing the Government in Wales to merge practice nurse and district nurse roles to create generic ‘primary care nurse’ posts closely linked to surgeries.

RCGP Wales outgoing chair Dr Paul Myres argued that patients currently get ‘fragmented’ care which lacks continuity because they have to see both district and practice nurses.

Dr Myres met chief nursing officer for Wales Dr Jean White last week as part of a group lobbying for the establishment of a task and finish group to examine the idea of generic nursing roles.

The Royal College of Nursing and other practices nurses were also part of the group.

Dr White did not wish to comment on her future plans, but said she was ‘considering’ the group’s proposal.

Dr Myres said: ‘Patients value continuity but they don’t always get it if they district nurses for one thing and practice nurses for another. If you create a generic role then this nurse could see patients in a practice or could visit them in their homes.

‘There’s a lot of commonality anyway between the practice nurse and district nurse roles now because district nurses often take on chronic disease management.’

Dr Myres finishes as chair of RCGP Wales this week after four years and will be replaced by Dr Rebecca Payne.

Readers' comments (9)

  • Well, duh! I've been saying for years that if community health services gave me back the 250k per practice they get for district nursing services, I'd be happy to employ three of four DN's to cover our patients, my PM pays them and provides HR and back office functions, and we have more than a bit left to invest in our own practice nursing services. But there is a pathological distaste for giving GPs more money or more control, so the current horlicks of a system continues. We used to have 2 or 3 DNs we all knew by name and they would regularly pop in to our practice to share notes. Now the whole lot are based in some shed on the other side of town, we don't know who they are, we just ring a "robophone" for referrals, they refuse virtually everything they used to do, and their sickness and staff turnover rates are astonishing. Madness. .

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  • Anonymous 7:18pm

    Agree entirely. Purely by random chance the RCGP might eventually, like the monkeys with typewriters, produce something sensible instead of the usual cardie nonsense; is this it?

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  • With due respect, DNs provide home nursing interventions for patients who are housebound, or where procedures are more appropriately carried out within the home. Those who are mobile, go and see their practice nurse. The DN work force is good value for money, but is under immense pressure as are others within the NHS-increased demands, under resource plus hard to recruit. Staff are going off sick with stress due to relentless pressure daily.

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  • What a clever idea. More integration of the community service please. As it use to be.. things go round in the NHS as usual... The DNs willget better support from GPs they know and the GPs get to know the DNs better. We can employ and support the DNs better. I am sure this sound advice will be completely forgotten as usual.

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  • But of course no one will want to fund it...
    Like they dont fund Practice nursing in an identifiable way.

    Ideally should be all part of OUR team or at least be aligned as they used to be before their own "trusts" thought they were the most important link in the primary care model not the practices - hence the shambles we all have at present

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  • This sounds too good to ever be true.. How about integrating school health as well? If managers ever bothered to ask the nurses working the floor what they think would make their jobs and lives easier and better, I'm pretty sure most of us would want to work closer with GPs. It's just obvious common sense!?

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  • Does this mean DNs will be employed by practices or GPs become salaried"

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  • Anon 9.15

    The DNs are a marvellous bunch, and thoroughly demoralised by having lost their direct contacts with the GPs. If they could be employed by practices, in a flexible way, so they could see some people at the practice and some at home (which may be the same patient at different stages of their illness or recovery) the DNs would be happier than they are now, and so would the patients and the GPs.

    Plenty of fantastic DNs have resigned because of increasing pressures and unsocial and inflexible shift patterns. I don't know how DNs employed by practices would cover the out of hours DN cases though - presumably by some form of a co-op like the GPs used to have.

    But if the DNs could have a base in a practice, and be fully integrated with the PN team, it might make them feel more valued (because believe me, we do value them), and part of a worthwhile team, rather than at the beck and call of managers always increasing their workload.

    This would be a great idea in theory - the devil would be in the detail though of course!

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  • Yes please! I'm a DN, I'd love to work more closely with the general practice team, more continuity, more job satisfaction, more accountability, seems like a very good idea!

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