At the time of writing the BMA, RCGP, NHS England and HEE had jointly published Building the Workforce – the New Deal for General Practice. This sounded promising. But primary care nurses were barely mentioned (once in point eight, out of 10). The document focused on improving the lot for GPs, and nurses were just lumped together with 'other staff', even though it did refer to piloting alternative ways of working in primary care. By focusing on doctors, the document reinforces the view of general practice as being all about the doctors, with nurses and HCAs as supporting acts. Yet, it is known that nurses do almost half the work in general practice (40 per cent) already. The document sets how more doctors can be recruited into general practice, how it can become a more attractive career (doctors being given an extra year to do MBAs, portfolio careers for older GPs at the end of their tether etc) but that alone will not make primary care deliver. That will depend on efficiently using a mix of skill levels, from HCAs to specialists.
The truth is, practice nurses fall outside of NHS England and the RCGP and BMA are doctors organisations. Practice nurses are employed by GPs. Until GPs acknowledge and understand how their working lives would be improved by backing a model of primary care reliant on skilled, knowledgeable practitioners at all levels, the practice nurse workforce will remain in a silo. If NHS England and HEE addressed the primary care workforce as a whole, general practice might once again become an attractive career for doctors and nurses alike. Integration not seperation.