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LETTERS: Sam Richmond Extended prescribing by UK nurses and pharmacists: Triumph of common sense BMJ 2005; 331: 1337 [Full text]

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appropriate context for nurse prescribing

andrew montgomery   (4 December 2005)

appropriate context for nurse prescribing 4 December 2005
andrew montgomery, locum New Zealand Send response to journal: Re: appropriate context for nurse prescribing	Dr Richmond asserts that nurse prescrbing is a "triumph of common sense". In the very narrow and highly specialised arena of neonatal intensive care this may well be so. It may also be appropriate in other highly specialised fields. The problems will arise where a broad knowledge of disease and its protean manifestations are required. It is a fact that specialist medical and surgical practitioners develop a blinkered view of general medicine. The same applies to the nurses who work within specialist fields. The patients they see have already been subjected to the generalist diagnostic sieve. The most difficult job in diagnostic medicine is that of the general practitioner. I would like to refer now to the New Zealand experience with maternity services. In the early 1990's pregnant women had a choice of providers - ie midwife , GP, and obstetrician. They were funded by the state to employ all three concommitantly if they so wished - and they frequently did so. In an effort to save money the Government forced pregnant women to elect a lead maternity services provider. The consequences of this decision have lead to the following outcomes. Firstly - a doubling of the cost of maternity care provision. Secondly - an almost complete exodus of GPs from maternity care - only fourteen in the country now deliver babies. Thirdly- in some relatively densely populated parts of the country - eg the Waikato - no private obstetrics services are available. Fourthly neonatal morbidity has increased. The New Zealand experience with regard to maternity care should have been noted and rung alarm bells in the UK. This is an example of how health professionals without full training have intruded into and taken over the role of doctors. It illustrates clearly the rule of unintended consequences. It is a sad fact that the UK is about to embark upon an experiment that the rest of the world will observe and learn from. Competing interests: author absolute idiocy