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Doctors are limiting nurses' ability to refer, survey shows

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by Joe Lepper

GPs and consultants are limiting advanced nurses' ability to refer patients to other services, according to the largest survey of the profession in six years.

The survey of 689 advanced nurse practitioners (ANPs), carried out by the RCN's Advanced Nurse Practitioner Forum found that 23 per cent of respondents had limitations put on their ability to refer, while a further seven per cent had no referral powers.

Cited barriers to nurse referrals included required GP sign off or peer review by another medical professional; and consultants refusing to accept a referral from a nurse.

Julie Hall, a member of the ANP forum (pictured), said: 'The reasons are complex. Sometimes it is because a specific group of consultants in an area will not accept any referral that has not been signed by a doctor.

'Another factor among GPs is that they are more conscious of cost and want to look over any referral to look at the cost implications.'

She called for greater awareness among local health communities of the role and responsibilities of advanced nurses.

'Getting trusts to help with this is a good idea, so they can spread the word,' she added. 'Interface between professionals across primary and secondary care can be difficult.'

Richard Vautrey, deputy chair of the BMA GP's committee, said a number of local medical committees (LMCs) are keen to help doctors in secondary care better understand the roles of advanced nurses.

'I would urge nurses to contact the LMC in their area with specific examples they can go to the hospital trust with,' he advised.

He added that referrals reviewed for cost reasons, 'is something all referrers are experiencing' as trusts and clinical commissioning groups increasingly want to see whether all avenues have been explored before referring to a hospital, such as seeing a GP with a special interest.'

The ongoing lack of regulation for advanced nursing was another concern highlighted in ANP survey, an issue also cited as a priority by respondents to the 2006 survey.

Ms Hall said: 'It is sad that over the last six years there has been so little progress on this.' She explained that regulation could give consultants and GPs greater confidence in the skills of advanced nurses.

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