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Nurse practitioners and the future of general practice

BMJ 2000; 320 doi: (Published 15 April 2000) Cite this as: BMJ 2000;320:1084
  1. John Alcolado, senior lecturer and consultant physician
  1. Llantrisant, south Wales

    In my daily clinical practice I work closely and happily with nurses who specialise in looking after patients with diabetes. An increasing number of tasks, previously the domain of doctors, are carried out by nurses. So why do I feel uneasy about the nurse practitioner in general practice?

    Firstly, I am concerned that the title is not protected. A newly qualified nurse can be a nurse practitioner. At present they tend to have considerable experience and maturity—they have often spent several years as practice nurses or sisters in accident and emergency departments. But what of the future? When I receive a referral from a medical colleague I make certain assumptions about their training and experience. They will have gone to medical school, been through vocational training, and, almost invariably, be members of the Royal College of General Practitioners. When I receive a letter from a nurse practitioner, I have no way of knowing the background of the individual.

    When is a nurse really a doctor in all but name?

    Secondly, I am concerned …

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