One of the principal architects of the GMS contract believes practices can offer 50 per cent more appointments if they cut GP numbers and recruit more nurses, Independent Nurse can reveal.

and where are all these highly trained advanced nurses and where is the money to train them

I cant beleive this man once represented the interests of GPs for the BMA.. He should resign from the BMA immediately.

Hasnt this guy caused enough damage with his ill thought out remarks on the OOH opt out ? Now he's at it again...to think that we were dull enough to allow him to act on our behalf....!!

How nice it would be if one could pluck trained, safe, autonomous nurses with unlimited indemnity from
trees and employ them instead of highly trained and experienced GPs. There is the little matter of discussing all the
uncertainties about a million things a million times a day with the said nurses all day long and sit around to mop up everybody else's liabilities. I for one will go and buy a cheaper water-resistant watch as opposed to waterproof.

I have just spent 10 years in education and training to become a GP and am now finding difficulties obtaining a substantial GP post. And I'm not the only one... Most of my recently trained colleagues are finding it difficult to get GP posts. Don't wish to sound bitter but has our training already not come at a high cost to the tax-payer? Why have medical school places been increased?

Chisholm represents a private firm. It is not surprising he suggests paring down staff in primary care because that would increase profits for Concordia in any primary care contract it wins. The first duty of such companies is to their shareholders, in stark contrast to GPs whose duty is one of care of their patients. Tthe language used by some of these companies reveals how they view the NHS as yet another business, using management 'Human resources speak', such as '...appropriate use of clinicans and using a skill mix to aid an effective patient pathway'. This company could just as well have been idscussin use of a JCB in a construction scheme. The problem with all this nonsense is that many people don't realise what is going on, despite all the 'public consultations' from the government. If I am unwell enough to seek medical care I want to see a doctor, not a receptionist or a nurse. As a phsyiologist I have been studying migraine for many years but would not dream of trying to give advice to anyone on how to treat their attacks. The whole government exercise is dishonest, it will undo years of thoughtful and hard work by GPs and their staff over many years and, in the end and it will dismantle the NHS, leaving those most vulnerable without access to care. For an excellent analysis of the situation I suggest: Pollock, A. British Journal of General Practice, 2006, August, pp565-6.

Dr. Fradd can talk big sitting in the ivory tower now that he is virtually out from the coal face work with real patients! I agree nurses can complement GP surgeries but increased number of appointments does not mean solution of problems that patients contact us for. Horses for courses.

For some views on Chisholm's Concordia take a look at this page:

http://nhsblogdoc.blogspot.com/2008/02/dr-chisholm-and-dr-fradd-are-honourable.html

I bet those nurses won't be on 10 minute appointments per patient and so might not be any cheaper than employing more GPs.

I find it rather sad that nurses are being placed in the firing line for adverse comments over this.  I agree that there is a shortage of nurses that are qualified, both academically and through experience, to replace a GP in primary care; this may be why one person has commented on 'discussing a million things a million times a day' - perhaps that shows a lack of confidence?  I personally cannot work out how utilising Nurse Practitoners can increase appointments by 50% - the financial aspect is easier as everyone knows nurses are a lot cheaper to employ (my turn to sound bitter).

It is also very disturbing to know that there are a lot of newly qualified GPs that are having difficulty getting posts. Is this due to partnerships not recruiting for financial reasons, whether for new partners or salaried doctors?  If so it is up to GP partnerships to address this problem. Perhaps some of these newly qualified GPs could take advantage of the opportunities in under-serviced areas to set up new practices. heaven knows there is a dire shortage in parts of Yorkshire!

Replacing GP's with nurses is medicine on the cheap ! Nurses are not doctors. They compliment Doctors and work with them to provide quality care for pt's. It is unsafe for pt's,nurses and doctors to even suggest this !

I would like to know " how many consultation this person ( whoever advocating for increasing appointments by nurses) had with Nurse practitioner on the receiving end ? Has he or his family prefer nurse consultation over GP consultation? If he did not have a single consultation with NP in the last 12 months then how can he justify for others?

Yes I agree with what you are saying about the cost; nurses ARE there to compliment doctors and provide quality care. 

However nurse practitoners are professionally qualified to degree level to see undifferentiated and undiagnosed patients; if they do not hold this degree then they should not be calling themselves a nurse practitioner as it is very misleading to both patients and health care professionals. Nurse practitioners are also expected to take responsibility for chronic diseases management by most GP practices, which is not the reason the role was created.

For the full defintion and list of abilities of a nurse practitioner go to  http://www.rcn.org.uk/search?queries_search_query=Definition+of+Advanced+Nurse+Practitioner as this provides the RCN guide about Advanced Nurse Practitioners.  The NMC also give the official definition as:

“Advanced nurse practitioners are highly experienced, knowledgeable and educated members of the care team who are able to diagnose and treat your health care needs or refer you to an appropriate specialist if needed.”