Dr Zara Aziz: Replacing GPs with nurses and other professionals is not the answer

I came back from my summer vacation rested and rejuvenated. The real world hit me after two minutes. I was back where I had started, surrounded by a palatable air of stress and time pressures.

This is hard to get away from, even if we feel secure in the cocoon of our own GP practices. This year has seen such unprecedented doom and gloom on so many fronts, including the NHS, that it almost washes over us now - except that it doesn’t. Every bit of news on funding cuts, recruitment and workload crises hurts more than ever because I know that it is for real - our NHS is unravelling before our eyes.

As trusts, CCGs and NHS England try by hook and crook to balance their numbers, we all become casualties. The GP Forward View talked of tackling burnout and disillusionment among GPs, yet there have been no solutions to big promises.

And the latest news that some areas have plans to reduce GP numbers and replace the costly creatures with physicians associates and nurses seems even more short-sighted.

I am all for increasing the pool of clinical expertise – in the last year we as a practice have engaged advanced nurse practitioners, a community psychiatric nurse (CPN) and a clinical pharmacist. They offer great care and continuity for some of our vulnerable and chronic disease patients. But this system works because GPs provide overall responsibility and supervision.

Is the NHS really ready for even more of a colossal shift away from the GP model? And how comfortable would we feel at being scaled down and 'supervising' other health professionals at a distance?

So far such teams have tended to work primarily because we are relatively small organisations with close-knit teams. Anything on a larger scale would need a model of more independent working, with allied health professionals (AHPs) having greater autonomy (with everything that entails, including indemnity and other costs).

No, we are not there yet. Patients, hospitals and even AHPs themselves look to GPs to bridge the gap – giving jobs new titles and extending roles does not necessarily translate into autonomous working.

Yes, we should have a diverse workforce of physician assistants, nurse practitioners, pharmacists, social workers and CPNs, but not at the cost of GPs.

  • Dr Aziz is a GP in Bristol

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