A new model for NHS care

A new model for NHS careKeywords:Better care, Nursing shortages, Independent polling, Reflecting patient needs

In February the British Medical Association (BMA) published a new ground-breaking model of how doctors and nurses in the NHS might provide better care for patients. In a discussion document, the Association said that nurses'skills would be used to their full potential by co-ordinating the care around a patient, while doctors would concentrate on the areas where their skills can be best used. Doctors would no longer be seen as the sole "gatekeepers" to the care that NHS provides.

In primary care, the first point of call for most patients could be a nurse practitioner, who would provide the patient with information and guide him/her to the relevant service. Often this may be a consultation with a GP, but it might also be with a community pharmacist, a family welfare worker, a benefits advice worker, or a combination of these.

In secondary care, a clinical nurse specialist would be responsible for co-ordinating the care given by other professionals including doctors, and would also have an advanced clinical nursing role.

Commenting on these proposals, Dr Ian Bogle, the chairman of the BMA, said:"The NHS certainly needs more resources, and I recognise the severe shortages in both the nursing and the medical professions. But those who work within the NHS need to take a long, hard look at how they work and how they might improve the service and care they offer. The ideas we publish today are for discussion. They are seemingly simple, but could reap enormous benefits for patients and professionals. Patients could be seen sooner by those with real expertise. Doctors could use their skills to greater effect, focusing on those tasks which require their advanced levels of clinical training and specialisation.

"Our independent polling has found that patients think that hospital consultants offer the best standard of treatment, and that they want to spend more time with their GP. However, if they are suffering from a minor ailment,they are more than happy to be seen by a nurse or advised by a pharmacist. This system reflects these wishes.

"These ideas are rooted in the reality of how the NHS works. They aim to overcome the confusion and frustration, duplication of effort, and waste of time and resources which are all too common in today's NHS. We look forward to discussing them with our nursing colleagues and with other professional bodies and the Government in the weeks ahead."

Under the proposals, savings could be achieved by:

• making the best use of doctors' clinical skills;

• making better use of time with fewer referrals, fewer hand-overs and less time spent locating other professionals;

• better co-ordination of services and prevention of repetition and overlaps;and

• better provision of information to patients and their families, preventing re-hospitalisation.

Support for the ideas comes from research by MORI. From 7-13 February 2002 they carried out 1,972 interviews with adults aged 15-plus, in-home and face-to-face, at 198 sampling points throughout the UK. They found that:

• 87 per cent of people would be happy to be seen by a nurse rather than a doctor, if their conditions were not serious;

• 84 per cent of people would be happy to see a pharmacist instead of their GP to repeat an existing prescription, if necessary; and

• 53 per cent thought that, if you want to be sure of receiving the best treatment, you need to see a hospital consultant and not someone less senior.

Commenting on the report, Dr Beverly Malone, General Secretary of the Royal College of Nursing, said: "This is an imaginative and constructive discussion document, which clearly acknowledges how well doctors, nurses and others on the health-care team can work together to deliver the best patient care. Nurses are keen to look at ways of breaking down traditional barriers and creative ways of working to improve care."

She said that the RCN has long argued that nurses are competent to deal with the wide range of ailments, illnesses and minor injuries that patients have, and that nurses are already assessing and treating patients and referring them on to other sources of advice, treatment or care, should this be in their best interest: "Nurses see wider prescribing rights as one straightforward way to maximise their potential – bringing care more quickly and effectively to their patients. Nurses are wholly committed to working in close partnership with their colleagues throughout the health service – they recognise that this is the only way to deliver the goals and aspirations of the NHS Plan."

Response from the Royal College of General Practitioners (RCGP) was rather more muted. Dr Maureen Baker, the Honorary Secretary, said: "Nurses are valued colleagues in Primary Care Teams and we need to look at using the precious time of all doctors and nurses in primary care in the most effective way. The BMA's discussion document suggests that a nurse practitioner could be the first point of call for most patients. However, patients who are ill and presenting undiagnosed symptoms need a full assessment and require the skills of a GP to make a diagnosis and reach agreement on a treatment plan. We would be very concerned, if the BMA's proposals put more barriers in the way of patients who need access to GPs for this service."

She commented that the College was aware of the problem of access, and that there is a shortage of both nurses and GPs. In a joint statement with the General Practitioners Committee of the BMA, the RCGP had previously outlined the need for 10,000 more GPs just to do the work in the NHS Plan. Dr Baker said:"We have great concerns that an increase in GP numbers will not happen, if the BMA's suggestions are taken on board, and that nurses are being expected to undertake the work of a GP without the equivalent training. The answer is not to compromise but for the government to put more funds into primary care".

The full text of the discussion paper The Future Health-care Workforce, A New Model for NHS Care is available online in the policy and reports area of the BMA Web site at: http://www.bma.org.uk/