BMA suggests nurses could become gatekeepers of the NHS

Nurses could replace doctors as gatekeepers to the health system if radical new proposals by the BMA are adopted. The discussion document published last week, represents an abrupt change of policy for the BMA, which has traditionally argued that doctors should be the first point of contact in the NHS.

The BMA proposes that in a primary care setting, nurse practitioners could assess patients with minor ailments. The nurse would direct the more serious cases to a general practitioner. Other patients could be treated by the nurse or sent to a pharmacist, therapist, or social worker depending on their needs.

A MORI poll commissioned by the BMA found that 87% of patients would be happy to see a nurse instead of a doctor if their condition was not serious. MORI conducted 1,972 interviews with adults between 7 February and 13 February 2002 at 198 sampling points throughout Great Britain.

Eighty four per cent of respondents said they would be willing to see a pharmacist to obtain repeat prescriptions. On the other hand, 53% said that only a hospital consultant could provide the very best treatment.

The BMA's change of heart on the gatekeeper role will lend impetus to the trend towards greater participation for nurses in primary care. Alan Milburn, the health secretary, announced last week new powers for nurses to prescribe antibiotics. Nurses also give treatment advice on the NHS Direct telephone service.

Health minister John Hutton said: “There are hundreds of nurse consultants now in place, we are bringing back matrons, and we are seeking to see nurses become chief executives of trusts. But this isn't just about nurses and doctors. It is also about the role of therapists and other healthcare professions.”

Dr Ian Bogle, chairman of the BMA, said: “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 is all too common in today's NHS. 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.”

Dr Beverly Malone, general secretary of the Royal College of Nursing, said: “Nurses are keen to look at ways of breaking down traditional barriers and look at creative ways of working to improve care. The RCN has long argued that nurses are competent to deal with the wide range of ailments, illnesses, and minor injuries that patients have. Nurses are already assessing and treating patients and also referring patients on to other sources of advice.”

The Future Healthcare Workforce: A New Model for NHS Care is accessible at http://www.bma.org.uk/