Editor—The BMA's suggestion that nurses might act as gatekeepers1 is not supported by the evidence from a three year study of NHS Direct West London linked to a cooperative population of 0.9m.2
Although the computer triage based on the medical model is intended to manage and control demand, evidence suggests that when nurses stopped being employed by the cooperative and became employees of NHS Direct, general practice referral patterns changed considerably. In particular, requests for visits by a general practitioner have now been transposed into the less costly requests for telephone advice from mobile visiting doctors. The nurses moved from being gatekeepers to being patient advocates, using a social rather than the more limited medical model of care. This greater sensitivity may also be why patients like talking to nurses.
The work by MORI, which performed the survey leading to the suggestion, is pointless if patients' attitudes were not surveyed at different points in the need continuum, as attitudes to health access change from the well to the ill.
Lastly, the BMA's proposal should surely have been in a joint report with the Royal College of Nursing if role boundaries are to be renegotiated in this way, especially if it has any chance of maintaining credibility with the public.
References
- 1.Dyer O. BMA says nurses could become NHS gatekeepers. BMJ. 2002;324:565. . (9 March.) [Google Scholar]
- 2.Mark AL, Shepherd IDH. Don't shoot the messenger—an evaluation of the transition from HARMONI to NHS Direct in west London. London: Middlesex University Business School; 2001. [Google Scholar]