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Should primary care be nurse led? No

BMJ 2008; 337 doi: (Published 04 September 2008) Cite this as: BMJ 2008;337:a1169
  1. Rhona Knight, portfolio GP, Leicester
  1. rk89{at}

    Nurses should be acknowledged as the true frontline providers of primary care, says Bonnie Sibbald (doi:10.1136/bmj.39661.707083.59), but Rhona Knight says that moving to a purely nurse led service would be a backward step

    Narrow minded? Lacking insight? Having been both a partner and a salaried doctor in a nurse led service, my view is informed by respect for the nurses I have employed, worked with, worked for, mentored, and taught. The roles of general practitioners and nurses—while dynamic—are different and complex. Each needs appropriate, role focused training.

    Nurses as effective leaders are not new. Florence Nightingale with her skills in leadership, evidence based health care, and nursing transformed care and saved the lives of many under her influence.1 2 As the NHS passes its 60th birthday, new 21st century Nightingales continue to venture into exciting, uncharted territory in both primary and secondary care. But concepts of nurse led primary care, where the nurse takes the place of a general practitioner as the first point of patient contact and leads the primary health care team,3 4 can restrict patients’ choice, lack supporting evidence, and raise many questions.

    The varied roles …

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