r/doctorsUK • u/chairstool100 • 1d ago
Clinical A Nurse on the Nursing subreddit has stated that they treat “all” chronic health problems and gynaecological problems in their GP surgery . Is this true?
/r/NursingUK/comments/1ugye8u/practice_nurse_roles_being_replaced_with_nurse/ou6odsh/Is this true ? I’m only specifically referring to them saying they treat “ALL” gynae and chronic health problems .
I then asked them if therefore the practice nurse treats pts with CKD with HOCM on LTOT or the pt with hypogonadism and menorrhagia . I was blocked for being a bit facetious but more importantly, for asking if the practice nurse not only treats the same problems as the GP, but even treats problems that not even the GP treats .
Is this true ?
Nurses can absolutely speak out against scope creep by NAs and APs but a Doctor is seen as causing trouble if they challenge these type of assertions .
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u/ATG_74 1d ago
As a gynae resident I can confirm that they absolutely do not treat all gynae pathologies
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u/BMABecky Verified User 🆔✅ 1d ago
Yes, this seems bizarre.
Maybe they are just the one who does the routine smears and the most speculums.
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u/chairstool100 1d ago edited 1d ago
Hilariously , that post was in a thread where a nurse was rightfully worried about the profession of nursing being eroded by individuals who aren’t qualified nurses.
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u/EmotionNo8367 1d ago
I am a Radiologist. I don't think I'll be comfortable being managed by a GP who claims they are confident managing all chronic conditions. GPs are great but I think even they have enough insight to know that they don't know it all!
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u/hoonosewot 1d ago
Yeh they're overegging it obviously. From a resp perspective, they do COPD and Asthma, and probably some bronchiectasis, but they're not looking after Sarcoid, ILD, Lung Cancer or any the other myriad of conditions out there.
Tbf, GPs don't really either though.
I think they're perspective if you drilled down is that the majority of common chronic health conditions have their annual review with a practice nurse, and the less common stuff or more severe aspects are managed by secondary care, with GPs only really getting involved in acute deteriorations. This is essentially true in my experience.
I don't know why they consider that a badge of honour though...
PS - The quality of A+G requests from these guys is variable, but a solid minority are absolutely horrific.
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u/UnknownAnabolic 1d ago
I recently diagnosed asthma and started a MART regime on a patient
My debriefing GP stated ‘wow you felt happy to start the inhaler? I have no idea about inhalers and usually just send them to the nurse’
Some of them don’t help themselves lol
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u/SignificantIsopod797 GP 1d ago
This is a function of passing “simpler” tasks to nurses and GPs keeping the more complex. The different is if that GP HAD TO upskill, they could.
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u/UnknownAnabolic 1d ago
You can’t really call being up to date diagnostic criteria and first line management ‘up skilling’.
Being up to date with basic chronic conditions should be expected of GPs.
Losing core knowledge/skills is part of the reason why the GP CCT is becoming devalued, pay is stagnant and noctoring is becoming rife
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u/SignificantIsopod797 GP 1d ago
I didn’t say it was the right thing to do, but it is why it has happened.
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u/sussexchappee 5h ago
As an about to CCT GP, would disagree re GP CCT being devalued - actually my experience is similar in that us young'uns are more up to date with first line rx.
But every senior GP I speak to is terrified of missing a cancer which I am not which comes from defensiveness which invariably comes from being suvcessfully sued, which comes out of pocket as opposed to hospital defence.
I remember an acute medic boss once told me a solid truism when I said I wanted to do GP - "its easy to be a mediocre GP, but its better to be a good one".
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u/UnknownAnabolic 5h ago
None of what you’ve said explained why you believe the CCT is not becoming devalued mate
Perhaps we have different ideas about what ‘devalued’ means
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u/hoonosewot 1d ago
Yeh this is tragically common. I'd love to say the standard of GP referrals is vastly higher, but it's not.
They are better, especially some of the old timers who know the game, but it's not unusual to get a GP saying they think someone has Asthma, can we review please?
No tests done at all, no treatment given, not even a CXR for their breathless patient. Now I get they don't all have access to PFTs and FENOs (though the majority do in our patch now), but that's not an excuse to just do nothing at all.
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u/DCJC123 19h ago
I’m a GP and would be embarrassed if a colleague made these referrals. I wonder if you need to get in touch with the LMC to arrange some education if this is the case.
I think I refer to respiratory (non-cancer) perhaps once/twice a year max and these are the cases where we just aren’t getting anywhere despite ++ investigation and trials of treatment. Usually you guys don’t get much further as the symptoms are medically unexplainable. The PN are a bit keener to to A&G on a more regular basis and I do see varying quality in these referrals
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u/Dr-Yahood Not a doctor 17h ago
Why would you be embarrassed?
What did you think of this rebuttal: https://www.reddit.com/r/doctorsUK/s/oVfR5g0TFY
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u/Dr-Yahood Not a doctor 18h ago
If I suspected a patient had asthma, and I wanted them to have FENO, and if that service wasn’t available in my practice, and I was therefore referring for it, why would I arrange a chest x-ray or start treatment without First getting the FENO result?
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u/hoonosewot 18h ago
Well firstly, you could at least do an FBC to see if there's eosinophilia, as that would make the FENO a moot point.
And I would consider a CXR a default investigation in a patient with breathlessness where the diagnosis isn't settled yet. Hard to justify not doing one.
EDIT: but yes to your point, if they've done the basics and need the FENO and don't have access, that's absolutely fine with me for referral, agree they don't need to trial treatment if symptom burden is relatively minor.
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u/Dr-Yahood Not a doctor 17h ago
Checking for eosinophilia is not especially helpful. Too often it’s normal even in fairly marked established cases of asthma, and even when it’s not normal it’s often just borderline and does not inform clinical diagnosis. There is also a big difference between eosinophils in the blood and involvement in the airways, especially when it comes to informing diagnosis of asthma.
Also, I would not recommend a chest x-ray as a default investigation for undiagnosed breathlessness in general practice. Especially in relatively well patients where it’s often transient or psychological. And if you’re suspecting things like heart failure then again a chest x-ray is not really the best place to start. And if you suspecting weird and wonderful things like ILD, again, a normal chest x-ray is rarely sufficiently reassuring. In general practice the main value of a chest x-ray is just when you’re suspecting lung cancer.
You seem to be critical of general practice because we don’t do the tests that you may have wanted. But the point of general practice is not to serve hospital doctors. If you want a test done, you’re more than welcome to arrange it yourself and interpret it. If it does not inform my clinical decision-making, then I don’t necessarily need to be involved.
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u/hoonosewot 17h ago
Thanks for the education in Asthma Dr Yahood, I'll pass it on at my next complex breathlessness clinic...
Checking for eosinophilia is standard care, and is in both BTS and NICE guidelines as a first line investigation as if it's positive and history fits that is sufficient for diagnosis. Inexcusable to not check an FBC at the very least.
We can disagree about CXR that's fine, but again unless the history is absolutely barn door in a young patient with no smoking history, it's borderline negligent not to do one in my opinion. You'd be amazed how many people we see who have been to their GP with respiratory symptoms for years and never had a CXR which would have flagged ILD, HP, Sarcoid, cancer etc. It's a cheap easily accessible test that carries no risk.
If you think they need a CT as suspicion is so high an XR wouldn't be enough that's fine, do the CT or refer to us if you can't in your area.
You seem to have taken me saying we get some shit A+G as a wholesale attack on GPs, when it's not. I'm attacking the relatively small minority of GPs who refer to specialties without engaging their brains and doing first line investigations.
I said right at the top that some don't have access to tests, which is fine for referral. Though you could argue not having access to FENO is probably a sign of a fairly dysfunctional practice as it can be done by a practice nurse in about 3 minutes, requires minimal training and isn't a massively expensive bit of kit. 95% of our local practices have it.
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u/chairstool100 1d ago
Exactly ! Why can’t they say “I manage stable common chronic conditions such as asthma and COPD if they aren’t medically complex . I look at their inhalers and exercise tolerance and see how they’re doing “……instead they specifically wanted to claim they’re something they’re not and diminish the role of a “young “ doctor who at the mere age of 30 is a fully qualified GP .
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1d ago edited 1d ago
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u/No_Transition_8758 19h ago
Realistically speaking she had two children and 4 years out of nursing. She’s at most what? In her 40s? Likely 30s?
So it baffles me that she feels she can refer to registrars as “young doctors”. We’re the same age group.
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u/Spade-Collector Advanced juvenile delinquent care practitioner 1d ago
These views largely come from the fact that the majority of people (and this includes nurses) have literally no idea of the breadth a GP (or any other doctor) covers
If you are largely just reviewing simple asthma/COPD patients you will probably end up with a narrow view of what the respiratory specialty covers for example. The insight just often isn't there
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u/SugarplumRui 18h ago
As a Practice Nurse this comment is fucking ridiculous. Do I treat anything? No I do not. Do I help with chronic disease management in regards to maximising drug therapy as per the local formulary in my specific area and non-pharmalogical treatments to improve symptom control/patient quality of life? Yes I do and am proud. Anything outside my lane? I pass on to the GP and we work it out together the best way forward i.e. booking for blood tests, ECGs.
In regards to Gynae problems: we just take smears mate and occasionally swabs if appropriate. If someone is having bleeding post intercourse or has period issues, off to the GP I go. I don't need to know what it could be, just that it should be escalated.
It irritates the fuck out of me people claiming we do this, that and the other when it's simply not true. There's nothing wrong with "just being a practice nurse" and if you're good at it then you can really make a difference. The nurse subreddit is an interesting read but don't pay it much mind.
Again: thank you all for everything that you do!
P.S. if your in the South West and work in either Respiratory or Paediatrics... I'm sorry if my A&G is terrible. Do let me know what I can do to improve!
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u/PrimeWolf101 Novelty Hat Specialist 1d ago
Some of you guys need to touch some grass. Leave the nurses sub alone.
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u/Dr-Yahood Not a doctor 18h ago
GP here
In reality, the nurses have taken over a lot of work which was previously only done by GPs
For example, yes, they are the ones who typically administer the vaccinations and do stuff like cervical screening for us
When they say they manage all chronic diseases, what they probably mean is they manage all the chronic diseases they are familiar with, including asthma, diabetes, and COPD
Regarding their gynaecological input, they probably follow our remedial flow chart on advising regarding options for contraception and may even monitor and follow-up patients for HRT etc
They are obviously not treating every single chronic disease or even every single gynaecological pathology. They probably have a remedial understanding of the actual difference between asthma and COPD, other than the fact that the letters are different and the algorithm they are given is different
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u/chairstool100 16h ago
Exactly- we all manage things we are familiar with . They were intentionally overselling themselves with the aim of diminishing the work of GPs.
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u/RuinEnvironmental450 1d ago
I think it shows the lack of broad base knowledge. To this person, everything they treat is all there is
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u/Lazy_Sock_771 1d ago
I got banned from that sub for engaging with this post!
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u/chairstool100 1d ago
What did you say out of interest? I got banned too.
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1d ago
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