Nurses to replace GPs

Nurses - and not GPs - could be the first stop for sick patients under radical new changes supported by the Minister of Health.

In a bid to limit the numbers of general practitioners suffering burnout from overwork, nursing bodies have proposed that nurses become the first point of contact for those in the doctor's waiting room.

Nurses say international research shows that 70 per cent of patients who go to a GP could visit a less qualified medical practitioner for treatment.

However, not all doctors support the move, saying it is a cheap shortcut for replacing more highly qualified, and highly paid, general practitioners.

In a speech to Otago medical students last month, Health Minister Pete Hodgson anticipated that nurses would do much of the work GPs currently do.

He quoted an article by the American Medical Association, which said nurse practitioners are likely to replace GPs to an extent as a point of first contact, and GPs are more likely to specialise in complex health problems.

"These shifts will not be without their challenges, amongst which is a threat, or perceived threat, to the doctor-patient relationship."

Hodgson told the Herald on Sunday that nurses were already the first point of contact in some remote areas, but nurses would never entirely replace doctors. "GPs know primary health care best, and GPs always will."

However, with an aging population more likely to die of chronic illness and disease, Hodgson said, nurses could bear more of the brunt of a doctor's daily workload in future.

"GPs earn good money, but they work pretty strange hours. They're our main primary health resource, and we don't want them to burn out."

The minister rejected criticism that hiring more nurses to do the work of doctors was a cost cutting measure. "This is not a central government push, the PHOs are doing this themselves."

Jonathan Fox, president of Royal New Zealand College of General Practitioners, said colleagues were concerned about the minister's comments, as there was already a shortage of doctors.

"We need to be training more GPs than ever.

"He is deluding himself if he says that nurses can take on more work and that we don't need more doctors."

Professor Campbell Murdoch, New Zealand's first professor of general practice, said Hodgson's plan to replace doctors with nurses on the frontline was because they are "cheaper".

"In 10 years time, the statistics will show how disastrous it all has been."

He said the doctor shortage and burnout arguments were a "red herring" and were simply an excuse for not spending enough on vocational training for general practice.

Most medical students graduate with a six-figure sum loan and either leave for jobs in better paying countries or those with less hours, Professor Murdoch said.

"The signs into rural New Zealand towns might someday resemble the signs in Waihola in Otago - 'No doctors, no hospitals, one graveyard'."

But Professor Jenny Carryer, clinical chair of nursing at Massey University, said research from the York School of Economics showed that 70 per cent of GP work could safely be done by nurses.

While she was not suggesting that nurses should replace medical practitioners, Carryer said: "If you sat in a waiting room for a day, you'd see people whose babies can't sleep or elderly people worried about falling over at night, people with sexual health concerns, relationship concerns, children with measles and mumps. None of this requires extensive training in bio-medicine to manage it."