Should primary care be nurse led? No

Sibbald 1 and Knight 2 put forward interesting arguments in respect
of nurses leading primary care services. What a nurse “can’ and “cannot”
do in clinical practice has been everybody else’s business since Florence
Nightingale raised the status of nursing to a ‘respectable level’ in 1860.
What is or is not considered within the scope of medical and nursing
practice is socially constructed and changes as technology and clinical
evidence advance. Fifty years ago taking a blood pressure was a medical
not a nursing procedure, now the task is delegated to nurses or care
assistants. Historical barriers such as unnecessary regulatory
restrictions, medical dominance and professional uncertainty about role
boundaries have long limited nurses’ contribution to primary care
services. As some regulatory restrictions have been lifted many nurses are
now providing patients with accessible, responsive, high quality first
contact health care. However, implicit and explicit medical dominance
continues to be evident in the literature and in clinical practice. For
example, traditional professional boundaries are re-inforced by the use of
terms like ‘nurse/doctor substitution’ which serve only to define nursing
in relation to doctors’ work. Knight 2 is one of many doctors who argue
that “ANP education is woefully inadequate” but this view fails to
acknowledge that nurses are different to doctors.

Perhaps it is time to consider that nurses have a distinctive role to
play that is different from being substitute doctors? Certainly patients
seem to think nurses offer something different – perhaps complementing
doctors rather than replacing them? For example, patients particularly
value nurses for their empathy and information-giving abilities and
doctors for their technical skills.3 4 Why not develop alternative models
of primary care service based on the different but complementary qualities
nurses and doctors bring to the clinical encounter? Appropriately prepared
nurses are more than capable of leading primary care services leaving
doctors free to specialise in their areas of interests.5 In the future
Primary Care Services should be designed by nurses and doctors (and other
health professionals) in equal partnership with each professional group
respecting the others’ contribution. This is surely the best way to
deliver high quality patient care.

References

1. Sibbald B Should primary care be nurse led? Yes BMJ 2008;337:a1157

2. Knight R Should primary care be nurse led? No BMJ 2008;337:a1169

3. Redsell SA, Stokes T, Jackson C, Hastings AM, Baker R. Patients
accounts of the differences in nurses’ and doctors’ roles in primary care
Journal of Advanced Nursing 2007;52(2):172-180

4. Cheater FM, Bonsall K, Edwards J, Leese B, McMurray R, Gill C,
Sutcliffe R What makes a ‘good’ first contact nurse in primary care. A
national study of patient perspectives and nurse aspirations. Final report
submitted to the Department of Health Policy Research programme, 2007.
University of Leeds.

5. Walsh N, Roe B, Huntington J. Delivering a different kind of primary
care? Nurses working in personal medical service pilots. Journal of
Clinical Nursing, 2003;12(3):333-340

Competing interests:
None declared