Nurses — the expanding role

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The expanding role of nurses

Nurses continue to extend their various roles within the NHS. Figures from the Nursing and Midwifery Council show that the number of UK practice nurses on the nursing register now stands at 19,846 for 2001-02 and that there are now some 12,224 community psychiatric nurses. With the new GP contract, there are likely to be significant developments in the future regarding the role of the practice nurse. Nurses will increasingly be the first points of contact in primary care, particularly with the requirements by government on GP access times. Evidence continues to show that nearly 25 per cent of GPs’ consultation time is taken up by matters that do not require their skills. So more delegation is sure to happen and this will likely challenge the traditional model for primary care in which the patient accesses the doctor as the initial point of contact. NHS influencers should note that in primary care, nurses are set to pioneer a course in ‘first-contact’ care at 10 PCT pilots. The course has been developed by the NHS University and the DH and is accredited by Sheffield Hallam University. First-contact nurses will assess, diagnose and treat patients in a number of different settings, including GP surgeries, walk-in centres, A&E departments and minor injury clinics

A primary care leadership programme has also been launched in the West Midlands for local PCT nurse directors. And Camden PCT is to appoint three primary care nurse consultants. In England the number of nurse, midwife and health visitor consultants is now up to more than 800, although mostly in secondary care. So the future would appear to be bright for nurses although we know that innovative posts in some PCTs are being held back because of lack of funds. There is some indication that local delivery plans are not accounting for these new roles and new responsibilities for nurses are concentrated on filling the more traditional roles.

Some personal medical services pilots (eg, Bromley-by-Bow health living centre in Tower Hamlets) are using nurse practitioners in performing 70-80 per cent of the work normally handled by GPs in areas like diabetes and asthma. Kate Cernik, lead nurse at the Appleton practice in Warrington said in the Nursing Times, ‘Doctors say to me, “you are becoming mini-doctors.” I say, “you have taken over nurses’ territory and we are just winning it back.”’ NHS influencers should expect even more nurse practitioners and nurse specialists over time. In the NT one is beginning to see more and more PCTs advertising for various kinds of nurse posts. These include NSF coordinators in primary care (eg, a PCT lead officer for CHD).