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This small book examines the potential for nurses to provide a first point of contact/consultation service as an alternative to going to see the doctor. The book is divided into three parts. Firstly, the problems faced by general practitioners are examined and possible solutions are sought from other healthcare delivery models. The conclusion of this analysis is that the nurse practitioner could take over much of the consultation work from the general practitioner. The second part of the book describes the impact of the nurse practitioner on patients and healthcare workers. It examines the results from one study in some depth and compares them with other similar studies. Three aspects are considered: what happens during a consultation, the service organisation needed, and changes in roles and relationships between doctors and nurses. Finally, based on an estimate of the value of nurse practitioners, the book looks at how this service could be implemented.
The book is based on the author's PhD thesis, and reads like a PhD thesis. While the topic is fascinating to healthcare professionals who are keen to develop models within different primary care groups, this format will put many readers off. The first part is too detailed and too wordy. Readers are well aware of the pressures they see in general practice. Some of the statements made about medical training are very dated and hence incorrect.
In the second part there is a lack of substantive analysis. There is no evidence that vague conclusions drawn from a few general practices in Derbyshire are generalisable. The section devoted to interactions between professionals could have been shorter, since readers will be well aware of colleagues' concerns when a new role is introduced. We were concerned about statements such as “patients like the nurse”, which are made without any measurement of outcomes.
The final section on practical steps contains useful information on how to establish these new roles and the importance of liaison. It is interesting to see that nurse practitioners are acceptable to colleagues and patients.
In summary, this book has a limited audience. It would be useful, however, as an example of how to perform a PhD.
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