Intended for healthcare professionals


The future of primary care nurses and health visitors

BMJ 2006; 333 doi: (Published 07 December 2006) Cite this as: BMJ 2006;333:1185
  1. Christopher Derrett, general practitioner (,
  2. Lydia Burke, senior lecturer (
  1. 1Barton House Group Practice, London N16 9JT
  2. 2Middlesex University, London N19 5LW

    Increasing fragmentation threatens the primary healthcare team

    New policies, new contracts, and financial pressures have altered the roles of primary care nurses and health visitors and their relationship with general practitioners (GPs). How will the primary care trust survive?

    In remote areas of some rich nations (such as rural Australia) highly trained nurses provide the core of primary medical care for adults and children. In many developing nations (such as Bangladesh and China) locally trained nurses tend to work in hospitals and private clinics in towns, whereas health care in rural communities often depends on lay medical aides and occasionally doctors. In the United States nurses manage care for chronic disease.1

    In the United Kingdom, some nurses are employed by independent contractor GPs, while others including health visitors are attached to general practice teams but are paid and managed by primary care organisations. They …

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