Nurses to replace GPs in new NHS

THE BIGGEST transformation of the NHS in its 50-year history, with nurses replacing GPs as the "gatekeepers" to care, was heralded by the Prime Minister yesterday.

The changes could spell the end of the family doctor providing for all the patient's needs. Instead, patients would receive personalised care based on their medical history from a variety of health professionals, according to their needs.

The change would be a natural development of Primary Care Groups (PCGs) - clusters of GP practices serving populations of about 100,000 - which replaced the GP fundholding scheme on 1 April. PCGs have already been compared to Health Maintenance Organisations in the US, which have responsibility for all the health needs of the populations they serve.

As forecast in The Independent two months ago, the first steps towards realising this vision were spelt out by Mr Blair yesterday in a speech in Birmingham to the first conference for PCGs, attended by 1,000 GPs, nurses and managers. He announced a network of 20 walk-in "health shops", to be led by nurses, where patients would be able to get instant care for minor ailments and which would be open from 7am to 10pm on weekdays. Mr Blair said: "The NHS has to keep up with developments in other areas of people's lives."

But the biggest change is to the NHS Direct 24-hour helpline, which is rapidly being developed as a new first point of contact for patients seeking medical care. The nurse-run advice line is to be given a bigger role in three pilot areas - the North-east, Nottinghamshire and west London - where it will field all calls to GPs out of hours. Other services to be tested include nurses making calls to check on patients. Advice will also be provided over the Internet with access points in post offices, libraries and accident and emergency units.

Stephen Thornton, chief executive of the NHS Confederation, welcomed Mr Blair's "inspirational vision" but warned it would lead to an enormous rise in public expectations. "A telephone banking style front-end to the NHS ... requires nothing short of a complete transformation. My concern is that we may get an exciting front-end to the service and the core services - properly staffed hospitals and good- quality cancer treatment - won't be able to keep up."

Mr Thornton said the plans spelt a "radical transformation of general practice" in which the first point of contact for patients would be a professional more like a nurse than a doctor. "It could perhaps spell the end of the family doctor."

Christine Hancock, general secretary of the Royal College of Nursing, said nurses were being given extra authority to help patients to treat themselves. "Nurses are good listeners and may be better placed to help people with common problems," she said.

But the British Medical Association said it was dismayed by the plans. Simon Fradd, deputy chairman of the GPs' committee, said the future of general practice was threatened. "GPs will no longer be co-ordinating everything. If you take over large chunks of the GPs' work it undermines the core service they provide and breaks the doctor-patient relationship. General practice could be fragmented, destabilised and even privatised."