Dr Phil Hammond, GP and broadcaster

Do we still need doctors? The discomforting thought that soon we might not need them popped into my head when I was the guest speaker at this year’s excellent Guidelines in Practice Awards.

Following my plug for the Awards in this column a year ago (great night out, swanky London hotel, fat cheque for the winners) there was a record number of entries, which the judges said were of the “highest quality” yet.

Winner in the NSF for Older People category was a team from Redbridge PCT led by nurse specialist Jocelyn Li. She’d done an audit of 15 care homes and discovered that 90% of the 500 residents were incontinent and the care staff lacked the knowledge and skills to help.

Now, I know very few doctors who would have done this audit in the first place. As my GP trainer used to say, “Don’t go turning over stones if you aren’t prepared for what crawls out from underneath.” And what GP could cope with 450 incontinent care home residents?

But Jocelyn and her team are made of sterner stuff and they devised and delivered an education and training programme to the staff, and carried out a systematic assessment of every resident. Continence strategies were tailored to individuals, with remarkable success and a huge cost saving.

And, most importantly, patients regained their autonomy, self-esteem and dignity. It may not be as sexy as heart surgery, but the impact on patients’ lives is just as significant.

Nurses in all their guises (PNs, NPs, nurse specialists and so on) featured heavily in the Guidelines in Practice Awards, and from where I’m sitting they seem to be taking over the NHS – but not yet getting paid for it.

Some years ago, I wrote a column asking: “Is there anything a doctor does that a nurse couldn’t do just as well and a lot more cheaply?” and the health service seems finally to have taken this on board.

All the chronic disease management, all the template filling, minor injuries, immunisations, emergency surgeries – indeed just about all of general practice can now be done by nurses, with GPs acting as a safety net for the chronically psychiatrically unwell, heartsink patients and those with conditions so rare that they don’t fit on any algorithm.

Ironically, nurses are now so busy doing what was GPs’ work that I find myself doing traditional nursing tasks (earwax, pill checks etc) because patients can’t get an appointment with sister.

My greatest service to patients is in ‘therapeutic gossip’ – something nurses were brilliant at but now don’t have time for in between the scales, the GMS template and the blood pressure cuff.

Practices now have clinical receptionists and healthcare assistants doing great chunks of the work, as patients book their own appointments and examine each other for lumps.

Everything is competency based, everyone is trained for purpose and there is no need for professional boundaries.

And if we’re not careful, there’ll be no need for doctors.

Guidelines in Practice, November 2004, Volume 7(11)
© 2004 MGP Ltd
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