Citizens juries vote to extend nurse roles

BMJ 1997; 314 doi: (Published 15 March 1997) Cite this as: BMJ 1997;314:769
  1. Jenny Bryan
  1. London

    Expanding roles for pharmacists and nurse practitioners and practical improvements in gynaecological cancer services are among the latest recommendations to come from a programme of citizens juries, supported by the King's Fund.

    The decisions come as a report from the Fabian Society out this week calls for wider use of citizens juries, saying that they can help health authorities improve their decisions and build public confidence.

    The authors say: “In attempting to understand the public's perspective, too many elected representatives rely only on a self selected sample of people who come to them via special interest groups. No wonder their messages fail to engage.”

    Jurors sitting in Sunderland, where there is a shortage of GPs, spent four days listening to expert and patient evidence before making recommendations including:

    • Continued development of nurse practitioner pilot schemes attached to general practice

    • Extension of the pharmacist's role in providing drug advice to GPs and monitoring repeat prescriptions (but not extending to diagnosis and initial prescription of drugs)

    • Exploring models for employing salaried doctors, ready for new primary care legislation

    Maureen Dale, quality manager at Sunderland Health Authority, said: “Many of the recommendations fit in with health authority plans and we will certainly be considering them at our next meeting in May.”

    In east Sussex, where gynaecological cancer services are fragmented, the jury was unanimous in recommending that the health authority should centralise services in Brighton and not leave individual hospitals to set up local centres linked to teaching hospitals.

    Other recommendations included:

    • Ending discrepancies in standards of care and treatment, waiting times, and facilities

    • Improving availability of counselling to patients from diagnosis onwards

    • Reviewing and unifying data collection

    Zoe Nicholson, commissioning and primary care development manager, at East Sussex, Brighton and Hove Health Authority, said: “We couldn't have come up with better answers, but getting this degree of change will be difficult because of disagreement among clinicians nationally about where gynaecological cancer should be treated. The jury has given us a steer for planning services in this area.”

    Other citizens juries coordinated by the Institute of Public Policy Research and drawn from cross sections of the general public in Portsmouth, Walsall, and Kensington and Chelsea have already reported on mental health and palliative care issues, and a final jury, in Buckinghamshire, was this week completing its recommendations on the management of back pain. The King's Fund will then evaluate the success of the programme.

    “At £13000-£20000 [$21000-$32000] for each meeting, the jury system is quite an expensive form of consultation compared to focus groups, surveys, and public meetings,” said Susan Elizabeth, grants director at the King's Fund.

    “We must now decide for what kinds of issues the citizens juries are a better method of consultation than anything that health authorities already have available,” she added.

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