I have just been reading the disillusioned ANP's letter about her experiences in general practice and being employed by GPs.
While I empathise with the reduction in funding allocated to GPs in general practice in balance with the increasing demand placed on primary care, I have observed that GPs grabbed with open arms the huge increases given to general practice via the Quality and Outcomes Framework (QOF) arriving in 2004. The government then, rather stupidly, gave money for points attached to things that, I hasten to add, should have been done anyway. My employers at the time were rubbing their hands together and gave nothing extra to providing services or increasing the staff. It is my view that now this overpayment is being retracted by further advances not being forthcoming, patients and other staff suffer the consequences.
Not only do nurses and reception staff in primary care have to do more for less, but GPs and practice managers often see highly trained practice nurses as competition for power. My two employers over the past 15 years have both allowed the practice managers to exclude nurses from having a say, being involved, and being a valued member of the team. It amazes me that managers, who are supposed to have people skills as part of their training, can have such protectionist approaches to what they see as their own power domain.
GPs partners seem happy to see this as normal, in spite of many practice nurses themselves having come from ward manager positions.
I am not saying practice nurses should also be practice managers but, in my experience of autocratic non-clinical managers, they often treat experienced adult nurses as little children to be seen working but not co-working.
Examples of this are GPs changing times of working and receptionists hours changing so that I am left with no reception staff because it is 'just a nurse' seeing patients. Whisperings in the next room where partners and manager meet about QOF and targets but exclude the nurses who have been trying to explain for months where QOF points are missing. Nurse-led clinics run, yet the GPs do not seem to understand that the nurse seeing the patients also needs to be aware of discharge letters relating to those patients.
Nurses in general practice should be considered and promoted as full members of the practice team, but since nursing magazines are not read by GPs or managers, it is likely these role issues will remain compartmentalised.
Anonymous practice nurse, Manchester
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