'Cut GPs by 88%' says GMS contract architect

Nurse triage means GPs only have to see 16% of patients.

Practices could cut waits and offer same-day appointments if they use nurse practitioners to telephone triage patients, according to a former GPC negotiator.

Nottingham GP Dr Simon Fradd, now chairman of GP-led firm Concordia Health, said the system also cuts the number of GPs required to run a practice by 88 per cent.

The firm is to use this model at two new east London practices it is opening next month.

Speaking at the Nurse Practitioners' Association conference in Liverpool last week, Dr Fradd said he had studied the results of replacing GPs with nurse practitioners at his two Nottinghamshire practices.

Apart from routine follow-ups, all patients are dealt with via telephone triage with a nurse. They are given an agreed time slot during which they will be called back.

Dr Fradd found that 46 per cent of 2,500 calls examined could be dealt with entirely by 'first contact nurses'.

Of the remaining patients, 21 per cent were seen by a nurse, 16 per cent by a GP, 13 per cent were 'lost' and the results for 4 per cent were unrecorded.

Waits fell from a fortnight to nothing for a face-to-face GP appointment.

Examples of work that could be dealt with over the telephone included depression, epilepsy, cystitis and test results.

Nurse practitioners in the audience asked how Dr Fradd's patients found the scheme.

'The majority took to it remarkably quickly. A lot of working people actually love it because they say they could never see a doctor. Now they don't have to come in they think it's terrific,' he said.

'I remember telling one patient they would have to come to see me and he said "I'm actually out walking in Kent".'

Dr Fradd said it would be easier to introduce the system at his London practices, which currently have no patients, than imposing it in Nottingham where there were already lists.

Dr Fradd added: 'Older people find it more difficult. There were patients who thought it was appalling and were determined to stop us.

'We had long discussions with one patient who wants us to make her an exception.'

neil.durham@haymarket.com

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