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Should primary care be nurse led? Yes

BMJ 2008; 337 doi: (Published 04 September 2008) Cite this as: BMJ 2008;337:a1157
  1. Bonnie Sibbald, professor of health services research, National Primary Care Research and Development Centre, University of Manchester
  1. bonnie.sibbald{at}

    Nurses should be acknowledged as the true frontline providers of primary care, says Bonnie Sibbald, but Rhona Knight (doi:10.1136/bmj.39661.694572.59) says that moving to a purely nurse led service would be a backward step

    Nurses and doctors have overlapping skills which makes it possible for one to substitute for the other within the area of overlap. In primary care this overlap is substantial. Systematic reviews of research indicate that primary care nurses can deliver as high quality care as general practitioners in the areas of preventive health care, routine follow-up of patients with long term conditions, and first contact care for people with minor illness.1 2 Within the range of care studied, no aspects were found in which general practitioners outperformed nurses. Indeed nurse led care tended to be superior in that nurses gave patients more information and patients were more likely to be satisfied.

    High satisfaction with nurse led care does not mean that patients inevitably prefer nurses to general practitioners. Patient preferences in most studies …

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