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Feature Medical workforce

Dr Nurse will see you now

BMJ 2008; 337 doi: (Published 09 September 2008) Cite this as: BMJ 2008;337:a1522
  1. Rebecca Coombes, freelance journalist
  1. 1London
  1. rcoombes{at}

    Nurses are increasingly taking on doctors’ roles but, as Rebecca Coombes reports, lack of regulation is making their acceptance more difficult

    “Dr Nurse,” “Noctor”—just two of many slights used to describe senior nurses who take on some medical roles or, worse still, take a job previously carried out by a doctor.

    But how far is this paranoia? In secondary care, nurses are doing endoscopy, minor surgery, and anaesthesia. The United Kingdom has between 3000 and 5000 advanced nurse practitioners, including those working at junior doctor level or higher. The number of registered nurse prescribers has grown 27% between 2004 and 2007 to over 45 000 nurses.1

    Former prime minister Tony Blair made a direct challenge to doctors by extending prescribing to nurses and pharmacists in the late 1990s. Health minister Ara Darzi, in his report on the NHS workforce in July, emphasised the need for increased investment in continuing professional development to allow existing staff to expand their roles. Health secretary Alan Johnson is said to be interested in using health centres run by companies such as Tesco and Virgin to swell the number of nurse-led practices.

    Professional resistance

    However, it is not a simple case of nurses marching forward unimpeded. There is a lack of good evidence to underpin nurse to doctor substitution. “There are studies around, but they are not a good design,” says Alan Maynard, professor of health economics at University of York.

    The drivers are clearly present to launch yet more nurses into quasimedical positions—for example, to cover for reduced doctor working hours caused by the European Working Time Directive and the pressure to meet clinical targets. But there are major impediments to a significant growth in Dr Nurses—including lack of professional regulation, low pay, and cultural objections by doctors.

    Nurses have made significant inroads in the past …

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