Intended for healthcare professionals

Rapid response to:

Head To Head

Should primary care be nurse led? Yes

BMJ 2008; 337 doi: (Published 04 September 2008) Cite this as: BMJ 2008;337:a1157

Rapid Response:

A few simple points

A nurse led service with restoration of the full gatekeeper role
probably could work.
A nurse led service would address the ridiculous contact rates of some

I like the idea of the GP as a primary care consultant. With time AND
RESOURCES, I suspect most GPS could reduce elective and even emergency
referrals to secondary care by up to 50 %.

With more time and dedicated time off every week to address their
knowledge needs, GPs could address some of their chronic knowledge
deficiencies in some areas that flow from the set up of the current
system. Nurses in primary care are already doing this.
Secondary care almost certainly would never release resources as a result
of a reduction in referral rates.

How would you fund the expansion of primary care without that release?

Reduction of the current GP workforce would create a "crisis" in medical
employment that could take 20 years to wash out of the system.
Traditional medical degrees would become somewhat obsolete. Why spend many
thousands and all those years if there were far fewer jobs and mostly in
secondary care?

Forget the term "nurses". Just train primary care physicians from the
start. A new medical degree would just be for potential specialists.
Actually many aspects of secondary care could be done by "nurses" even
more easily than primary care.

This whole debate could go around in a circle and you end up with a new
breed of doctors/nurses or whatever you want to call them.
Reduction of salaries as a result of nursing taking over, will mean
applicants will likely change signficantly. Many doctors like earning well
and would not be interested in a career at half the pay.

and so I could go on.

Competing interests:
None declared

Competing interests: No competing interests

25 September 2008
Graeme Mackenzie
North Cumbria