Medical practices led by nurse practitioners

There are significant resource pressures at doctors' surgeries.

The demand for GP appointments continues to grow. The capacity for GP teams to take on more and more work is limited. The demand on GPs' time will continue to increase due to targets for general medical practice, higher patient expectations, and an ageing population. Inevitably, the pressure on GPs' time leads to an increase in consultant referrals and patient attendance at A&E. 

To recruit more and more doctors is not an option for continuous and sustained improvement in general medical practice.

My suggestion is that general medical practices are led by highly trained advanced nurse practitioners. Nurse practitioners would offer specialisms such as ante-natal care and family planning, diabetes management, asthma support etc. Nurse practitioners would be qualified as extended formulary nurse prescribers which would allow such nurses to complete most consultations that required medication without involving the GP.

Patients' first-contact would be with the nurse-led service who would assess and give advice for patients with a new or existing condition. The nurse would have access to a GP throughout his / her sessions, and could request a second opinion or refer patients to be seen immediately. Nurse practitioners could refer patients to medical consultants, refer for blood tests and scans, analyse test results and arrange patient admission to a hospital. 

Patients requesting an appointment would be offered the option of seeing a nurse practitioner (with a specialism as appropriate); patients who preferred to see a GP would do so in the usual way. In the fullnes of time, a patient's intial contact would be with a nurse practitioner. 

Nurse practitioners would undertake face-to-face appointments, telephone consultations dealing with test results and queries regarding medicines, home visits for the elderly and / or house-bound patients involving the most appropriate member of the nurse-practitioner team.

Doctors would focus on patients with more complex needs.

Time would be created for GPs to develop their clinical interests.


Why the contribution is important

A first-contact, nurse practitioner led service would improve access to assessment and advice for patients with a new or existing condition. Most patients would be assessed, treated, (and discharged) in one single episode of care.

There would be a reduction in GP workload associated with the management of patients presenting for the first time or those needing advice or reassurance about their ongoing treatment.

GPs would be able to focus on patients with more complex needs including minor surgical procedures.

GPs would have the time to develop clinical interests to support patients with more complex needs. It would be reasonable to assume a reduction of patient referrals to consultants as GPs enhanced their professional qualifications.

A career-path would be available to nurses wishing to develop their expertise in triage, extended nurse prescribing, and first-contact protocols.

There would be fewer, more highly qualified doctors.

Patients would have the opportunity to see a specialist nurse practitioner in a range of medical fields which reflected the needs of the community.

Patients would continue to have the option to see a GP.






by newbroom on May 01, 2017 at 03:39PM

Current Rating

Average rating: 4.8
Based on: 5 votes


  • Posted by madeleine May 02, 2017 at 21:51

    one hundred percent support, about three quarters of us at a rough estimate would rather talk to a nurse than see a doctor. Let's save dr's hours and replace them with nurses. One doctor at a practice rather than three or four to see serious cases or emergencies. In Ramsey the dr can be based at the hospital and the local surgery completely staffed by nurses and the receptionists!!! Costs cut in half!
  • Posted by Geraldine May 04, 2017 at 21:11

    Great idea!
  • Posted by ninjadispenser May 06, 2017 at 17:17

    There are already Specialist Nurse Practitioners in Asthma/Diabetes and other Specialities.In surgeries,the are Supplementary Prescribing Nurses who can prescribe medicines already agreed by the Doctor and Independent Prescribers who can be Nurses,Pharmacists and others who have. Prescribing 'formulary' a bit like Dentists who have a restricted list of drugs they may prescribe.
    What would be helpful is if the Surgery used this resource to review new medications before 2-3months supply is prescribed to ensure the patient is tolerating it and is happen to continue long term,then can add it to the repeat list.This saves Doctors time and properly uses the expertise that the Nurse has gained. Surgeries in England have an 'in house' Pharmacist to deal with all of this and they have to be Independent Prescribers too.
    We have Independent/Supplementary Prescribers at Nobles Hospital who work in Manx Emergency Doctors area and are a welcome addition to the overstretched weekend service.
  • Posted by Hemmingway May 08, 2017 at 11:08

    100 % agree with the idea of making much greater use of nurses in Health Practices.
    Increase the number of nurses in Health Practices and this should lead to less unnecessary referrals by GPs to consultants at Nobles.
    Recently I personally have had several minor ailments.
    Each time I attended the Surgery I saw a GP - I was never examined by any of the GPs (who all appeared to be tired/uninterested/and devoted to the computer screen). Each time I was referred on to hospital consultants with vague letters such as "Please look at Mr Hemmingway's mouth" etc.
    Later, speaking to some nurses - they correctly diagnosed the minor problems and the necessary treatments.
    The consultants I saw at Nobles seemed perplexed that a lot of people with minor problems were being referred to them by GPs.
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