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Monday, 8 September 2008

The role of the doctor...

...seems to be being undermined once again.

This time the issue is being debated in the British Medical Journal.

Bonnie Sibbald, Professor of health services research at the University of Manchester argues that nurses can deliver as high quality care as GPs in most areas of general practice including preventive health care, the management of long term conditions, and first contact care for people with minor illness. And as such, should be the frontline providers of primary care, taking the place of GPs as the first point of patient contact.

But, thankfully, we do have, in Dr Rhona Knight, a GP from Leicester and who has first hand experience in a nurse led practice, someone to fight the corner of doctors. Dr Knight quite rightly points out that nurse led primary care would restrict patient choice and undermine the importance of nurses’ unique contribution to primary health care.

We must remember that GPs' shouldn't and can't be subsituted, with Dr Knight highlighting the difference in training for doctors and nurses. To become a general practioner, it takes 10 years and once qualified, they become hugely experienced in dealing with undifferentiated illness which enables them to be key deliverers and leaders of generalist healthcare. In contrast, she says, advanced nurse training is less developed and recommends a minimum of only 500 indirect or direct supervised hours and the competencies cover "just nine pages".

The erosion of the role of the doctor in some areas is something the BMA's annual meeting this year thoroughly condemned and must be resisted - let's get it straight, if someone wants to take on the role of a doctor - then bite the bullet and go and train as one.

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