Analysis

How nurse prescribers are filling in for GPs with the help of a web-based consultation service

Deploying a team of nurses to manage long-term conditions has helped one GP avoid the need to recruit more doctors for her Lanarkshire practice

Deploying a team of nurses to manage long-term conditions has helped one GP avoid the need to recruit more doctors for her Lanarkshire practice


Sharon Ghani, nurse manager for the Burnbrae Medical Practice in Lanarkshire,
says a team of four practice nurses have eased the sole GP’s workload

Susan Arnott of the Burnbrae Medical Practice in Shotts, Lanarkshire, was struggling to fill vacancies caused by the retirement of three other doctors in the space of 18 months.

‘We advertised for a new GP colleague, but we didn’t have any suitable candidates over a period of about eight months,’ Dr Arnott says.

‘We were getting to the point where practice sustainability was going to be an issue – 5,000 patients and a single-handed GP.

5,000

The number of patients the sole GP at Burnbrae Medical Practice in Shotts, Lanarkshire, oversees

‘Our options were either to try and persevere and get another GP or do something entirely different.’

e-consultation service

She settled on the latter and began by introducing an e-consultation service called askmyGP to give patients a choice in how they access the practice.

‘It’s a secure web portal available through our website,’ Dr Arnott says.

‘Patients just click on the portal and it asks three basic questions: what are your concerns? What are your expectations? And how would you like to be contacted – telephone, email or face-to-face?’

‘We have heavily relied on the presence of the multidisciplinary team and the experienced nurses we have. They’re all autonomous, highly trained practitioners. They’ve been invaluable’

Susan Arnott, Burnbrae Medical Practice

Nurses in the practice were essential to the system’s success, she says.

‘The e-consultation platform is only one thing we’ve done to transform the way we work, but we have heavily relied on the presence of the multidisciplinary team and the experienced nurses we have.

‘They’re all autonomous, highly trained practitioners. They’ve been invaluable.’

Dr Arnott triages inquiries as they come in and, unless she needs to the see the patient, they are passed on to the most appropriate member of the team.

Assuming responsibility

‘At the moment, all requests come directly to me, but the next step is to open it up to other members of the team for them to take part in e-consultations.’

‘Presentation, diagnosis, investigation and treatment and management for long-term conditions are all done by the practice nurses’

Sharon Ghani, Burnbrae Medical Practice

The practice’s nurse manager Sharon Ghani says a team of four practice nurses, three of whom are prescribers, have eased Dr Arnott’s workload by assuming responsibility for all patients with long-term conditions.

‘They’re completely managed by the nursing team,’ she says

‘It would only be for anything complex, out of the ordinary, that we would have to go and see the GP.

‘Presentation, diagnosis, investigation and treatment and management for long-term conditions are all done by the practice nurses.’

An advanced nurse practitioner, with long experience of the emergency department, is also available to manage acute illness, and there is additional support from an NHS-employed mental health liaison nurse and an advanced physiotherapist practitioner.

New ways of working

But change always take time to bed in. How have patients taken to the new ways of working? Are they content to see a nurse rather than a GP?

‘Not all of them,’ says Ms Ghani. ‘Some feel as though they’re perhaps being short-changed. But we’re trying to change that mode of thinking.’

Shotts is a former mining community so respiratory disease is common among patients, many of whom are smokers. Then there are the usual long-term conditions, such as diabetes and heart disease.

‘The nurses here have all done extra training in all of these disease areas to help us to manage patients,’ Ms Ghani says.

‘GPs are generalists. They know a little about a lot of things, but we know a lot about a few things.

‘Dr Arnott will often say to patients: “You’ve asked to come and see me, but I can’t help you with this. You’re going to have to see one of the nurses because they have expertise in this condition”.’

Patients do not appear to be leaving the list because of the changes that have been introduced. ‘And we do seem to have patients joining from other practices because they’ve heard the system works,’ Ms Ghani says.

‘A lot of people with a health concern are happy to type out an email in the morning, send it off, go to work and check their emails at lunchtime. The doctor will have reviewed it and emailed them back with advice.’

Positive feedback

When patients have used askmyGP, they are able to feedback to the practice their views on the system. Dr Arnott says around 75% of the feedback is positive.

‘We can’t please all of the people all of the time, but we have a lot of return users – people who use the system once and come back and use it again.’

75%

of patient feedback about askmyGP has been positive

Introducing a web-based consultation system raises obvious questions about accessibility. What happens to those who either will not or cannot go online?

It makes no difference, says Dr Arnott. Patients who phone rather than email speak to one of the reception staff who use the same online portal to log their inquiry.

‘So anyone who contacts the practice gets asked the same questions,’ Dr Arnott says. ‘No one is treated any differently.’

Part of the challenge, she suggests, is managing patients’ expectations.

Support and promote nurses

‘People need to appreciate that the nurses are highly trained and experienced. They know what they’re doing.

‘If people have always been used to seeing a GP and have various misconceptions about what a nurse can do, then obviously sometimes they have a different perception. But we work hard to support the nurses and promote what they can do.’

Asked whether the new approach adopted by the practice has increased job satisfaction for the nursing team, Ms Ghani says: ‘It certainly has for me.’

‘Dr Arnott is always there to support, guide and help us. If we do ever feel out of our depth, she doesn’t hesitate to pick up from where we’ve left off’

Sharon Ghani, Burnbrae Medical Practice

She adds: ‘All the nurses are happy with the system here because there’s a fantastic support network. We’re not sitting there with a patient, thinking: "Oh my goodness, where do I send this person? What do I do?" because we’ve got all bases covered.

‘And Dr Arnott’s a fantastic GP – she’s always there to support, guide and help us. If we do ever feel out of our depth, she doesn’t hesitate to pick up from where we’ve left off.

‘We all know we’re pretty fortunate.’

Nurses at the helm ‘is the way general practice is going to go’


Nurse manager Sharon Ghani

Could other primary care teams replicate what Burnbrae Medical Practice has done in implementing new ways of working?

‘I don’t think they could easily replicate it,’ says nurse manager Sharon Ghani. ‘It doesn’t come without its problems. 

‘We’re fortunate in that it’s a small team and everyone has been happy to change and to go with it. It wasn’t a case of: “Right, this is what we do from now on”.

Everyone needs to be behind it

‘You need everyone in the practice to be 100% behind it otherwise it’s not going to work.

‘This is definitely the way general practice is going to go because there’s a GP recruitment crisis.

‘But there needs to be a change in how patients understand the process and where to get help, rather than just demanding to see a doctor.’

 


Daniel Allen is a health writer

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