Nurse practitioners in the UK give patients another choice.

Being a nurse practitioner (NP) in general practice in the United Kingdom (UK) and having prescribing rights mean patients have another choice, says keynote speaker at last month's Goodfellow Symposium at the University of Auckland, Wendy Fairhurst-Winstanley (see right). Since 2004, Fairhurst-Winstanley has been in full-time partnership with her GP colleagues at a general practice in Wigan, Lancashire. She has been an NP since 1995. In an address entitled Innovation and partnership in primary care: challenges and opportunities, she outlined the potential for nurses in primary care, while acknowledging the differences between New Zealand and the UK.

Although Fairhurst-Winstanley completed her masters in clinical nursing in 2000, she told Kai Tiaki Nursing New Zealand there was no real standardisation of education for NPs in the UK. "There are some programmes at bachelor's and some at master's level, though people are encouraged to work towards their masters. We don't have to define our scope of practice formally with the nursing council and there is as yet no protected registration for the NP title. However, the question of protected registration has been agreed by the nursing and midwifery councils; we are now just waiting for the government to approve the legislation."

Fairhurst-Winstanley has had prescribing rights since May last year, with the full medical formulary open to her. She is the only nurse in her practice of three nurses, three full-time equivalent doctors and a health care assistant to have prescribing rights. The practice has around 5000 registered patients, which is about average for the UK.

"You don't have to be an NP to be a nurse prescriber in the UK. What you need is an employer who sponsors you to do the six-month prescribing course if he or she believes your role necessitates your becoming a prescriber. Being able to prescribe has transformed my practice because it means I can be more autonomous. Some nurses who have prescribing rights don't use them as much as they could and some find it all a bit scary. Having the support of your GP colleagues is important. Unfortunately, there is still some animosity among the medical profession about nurses having prescribing rights, but I hope this will lessen as nurses show they can prescribe safely."

Prescribing rights are granted at different levels, she said. There is independent prescribing; a form of collaborative prescribing; and the right held by some community nurses to prescribe basic things like dressings and paracetamol. In her practice, she works in a similar way to the GPs, with routine appointments and a system of acute appointments, where patients who want to be seen that day will see either the NP or a GP, depending on who is available.

Less pharmacological approach

"As an NP, I offer another choice to patients. NPs can operate a bit differently from doctors and have a different approach. That appeals to some patients. My approach may be slightly more informal than that of my GP colleagues and I may emphasise health promotion and prevention a little more, though many doctors offer holistic care too, not just nurses. We may take a less pharmacological approach to treatment, eg talking about diet, weight, smoking. There is certainly a need for more research into the differences in care provided by GPs and NPs. Two systematic reviews have already shown high patient satisfaction with NP consultations."

In the UK, chronic disease management is undertaken primarily by primary care nurses, she said. Nurses in these roles can prescribe, adjust and increase medications, initiate medication changes in discussion with the GP, and refer people to hospital if required. Although the National Health Service is being whittled away, with more privatisation of health, Fairhurst-Winstanley believes nursing opportunities will not change. "They are too well established now."

She is also convinced job satisfaction among nurses in general practice is higher than nurses working in hospitals, where the workforce is really under pressure. Traditionally, GPs fund the training of practice nurses, who become highly skilled in their field. This makes it very hard for nurses from the secondary sector to transfer into general practice.

"But I am concerned there is no prospective planning for the future training needs of practice nurses. Primary care trusts offer some training but they need to plan for the future, as those nurses in general practice now are all getting older."

Fairhurst-Winstanley's enthusiasm for clinical practice is evident, but she also enjoys her contact with learners during her teaching at Manchester University. Her other roles include reentering doctors and nurses in general practice and supervision of some junior doctors.