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Where are all the community advanced practice nurses?

As community advanced practice nurses can cost less than GP services, Bethann Siviter asks the important questions; where are they, and why is there not more available?

Community advanced practice nurses are cheaper than GPs and offer high-quality care, so why aren't there more of them?

I met a woman in the market. Her mother had been one of my district nursing patients. She was cheerful, until I asked how her father was. 'The district nurse wont come' she said.

I asked why not. 'Cant get nurse until he sees the doctor. Cant see doctor until he makes a home visit. No more regular doctors in the surgery. Theyre all locums and none of them visit.'

Her father is 90 with advanced Parkinsons, chronic obstructive pulmonary disease and type 2 diabetes. Hes frail, confused and struggles to move. I know this because I decided to visit. He had small pressure areas and was thin as a stick.

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Community advanced practice nurses are cheaper than GPs and offer high-quality care, so why aren't there more of them?


Implementing advanced nurses in general practice could greatly benefit nurses' workloads
Picture: iStock

I met a woman in the market. Her mother had been one of my district nursing patients. She was cheerful, until I asked how her father was. 'The district nurse won’t come' she said.

I asked why not. 'Can’t get nurse until he sees the doctor. Can’t see doctor until he makes a home visit. No more regular doctors in the surgery. They’re all locums and none of them visit.'

Her father is 90 with advanced Parkinson’s, chronic obstructive pulmonary disease and type 2 diabetes. He’s frail, confused and struggles to move. I know this because I decided to visit. He had small pressure areas and was thin as a stick.

'He won’t eat, I can’t make him,' his worried daughter said. She has full responsibility for his care, but is nearly 70, with arthritis, diabetes and degenerative disc disease.

'Nurses see people not just for their blood work and diagnoses, but for their social circumstances, care needs and overall health'

A few phone calls later, the surgery’s nurse agreed to visit (having friends in the business helps). Once she visited, the referrals were made and community nurses now visit, supplements have been prescribed and they're waiting for council care support.

A doctor visit was not needed. The man's needs were in care and nursing. Surgeries must rely on locum doctors who don’t know the patients, the communities or the local system… the mantra 'treat the patient, not the disease' has gone down the soil pipe. Case managers are gone.

Make a change

Two changes could make a dramatic difference: the implementation of advanced nurses in general practice and better integration of general practice and community nurses.

Nurses see people not just for their blood work and diagnoses, but for their social circumstances, care needs and overall health. Doctors might aspire to that, but it’s not in their model to do so.

Community advanced practice nurses are not only cheaper than GPs, they offer a high standard of care – especially for those with complex chronic needs. So where are they? 


About the author

Bethann Siviter is an independent nursing consultant in the West Midlands.

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