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Report warns of ‘inherent risks’ with nurse-led GP practices

One of the country's leading GPs has issued a stark warning about the risks of allowing nurses to run GP practices, after an inquiry into care at one surgery revealed a catalogue of ‘serious deficiencies' in safety.

Professor Mike Pringle, former chair of the RCGP and director of education at the Collingham Healthcare Education Centre (CHEC), which carried out a review into failings at Downham Market Health Centre in Norfolk, said the findings cast doubt on the future of nurse-led primary care and highlighted the risks of practices being staffed mainly by locums.

Experimental nurse-led practices were first established ten years ago in a bid to explore a cost-effective alternative to traditional general practice, and there are now around 20 across the country, along with dozens of nurse-led walk-in centres.

The CHEC report was commissioned by NHS East of England after four serious incidents at the PCT-run practice in 2010/11, including a patient who later died in acute care following advice from a locum working at the practice. Read the full report here.

It found there were allegations of bullying, GPs working at the surgery had had no clinical supervision ‘for several years' and even that locums ‘were often recruited by reception staff'.

The report also suggested the SHA consider a policy of only allowing GP locums to work in-hours shifts if they are on the performers list of a PCT within the same SHA or a neighbouring PCT - as some areas have stipulated with GP out-of-hours following the case of Daniel Ubani.

Professor Pringle said: ‘There is less of a tradition of nurse leaders in primary care than general practice leaders. PCTs need to be very well aware of the risks and the increased management problems that may arise.'

The report found there were ‘inherent risks in nurse-led practices' and concluded: ‘Some nurse-led practices have thrived; however, many have failed.'

Any nurse leading a GP practice would need to ‘break the mould' to succeed, it said, adding that ‘interpersonal skills, even charisma, clinical competencies and management skills' were ‘unusual' attributes among nurses.

Paul Cracknell, interim chief executive of Norfolk Community Health and Care, said the practice had been under new management since March.

‘We have specifically improved our medical leadership through appointing a substantive medical director who is an experienced and practicing GP, as well as the new post of associate medical director – again filled by an experienced practitioner,' he said.

Read the full report here


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