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Thursday, 28 February, 2002, 13:48 GMT
'Patients love our nurse-run surgery'
waiting room
Patients may even prefer seeing the nurse
Doctors' leaders say that a nurse may be the first point of contact for many patients visiting surgeries - but how does this work in practice?

BBC News Online looked at one pioneering practice in Derby - where the nurse leads the practice team - and employs the GP.

The Meadowfields Practice is probably the only one of its type in the country.

Most surgeries have "GP principals" - family doctors who run the show, and pay the salaries of other professionals, such as practice nurses, receptionists and managers.

However, at Meadowfields, there is a "Nurse principal" - Catherine Baraniak.

According to the British Medical Association (BMA), her practice may become a model for the surgery of the future.

A shortage of doctors means that they have to work smarter, not just harder, and that patients with conditions which could be helped by the nurse should not necessarily take up their time.

Catherine Baraniak opened the surgery in August 1998.

It offers its 3,000 patients a choice of seeing either a nurse, or a GP. Most choose the nurse.

She can order routine tests, give health advice, carry out some treatments, and even refer the patient on to a consultant if test results suggest that should be the case.

At that point, the BMA had a slightly different view of what nurses should be allowed to do.

She told BBC News Online: "They sent out a guidance note to hospital consultants saying that they should not accept patient referrals from nurses."

Charm offensive

However, over the past few years, she has gradually won hospital specialists over to the once-heretical notion that a nurse could do all these things.

We feel it's the right thing to do, to offer a choice between seeing a nurse and the GP

Catherine Baraniak, nurse principal
And in a survey of southern Derbyshire practices, in terms of patient satisfaction, Meadowfields tops the lot.

Unlike many surgeries, you do not have to phone for an appointment here - just turn up.

Ms Baraniak said: "We feel it's the right thing to do, to offer a choice between seeing a nurse and the GP.

"Of the 35% who choose the GP, we would say that about half of them make the right choice.

"Many of them think that nurses can't do things like write sick-notes - when in fact we can, we just have to give them to the GP to sign."

More time to spare

The practice GP - formerly a principal himself in another surgery - in enjoying his new incarnation.

We've proved this can work - and that patients like it

Catherine Baraniak, nurse principal
His new boss said: "He has said to that that in his former life, he knew he was busy, with lots of people to see, and that if he had a patient with a significant problem he would not have the time to see it properly."

Now, while the average consultation time is about 10 minutes - a few minutes up from the national average of seven, on Thursday morning he spent half an hour with one patient who needed extra time.

While this surgery is winning high praise - from both patients and now even the BMA, it is hard to see how it could be reproduced easily across the country.

At present, although the government has launched an initiative to train up more nurses to prescribe extra drugs, the lack of extra funding means that few doctors can afford to let them miss work to learn these skills.

As a result, some practice nurses may be unable to embrace these changes.

Catherine Baraniak said: "We've proved this can work - and that patients like it. The ball is in the government's court now."

See also:

28 Feb 02 | Health
Surgery balance of power shifts
27 Feb 02 | Health
Nurses hit language barrier
22 Feb 02 | Health
Appraisal deal for GPs
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