DOCTORS warned that patients are being put "at risk" as specially-trained nurses replace GPs in parts of Scotland to help plug a shortfall in family doctors.
The Royal College of GPs Scotland condemned plans by NHS Highland to deploy advanced nurse practitioners (ANPs) for frontline patient care, without the supervision of GPs.
Responding to a consultation by Holyrood's Health and Sport Committee, the professional body - which represents around 5000 GPs in Scotland - added that the policy risked sending a message that general practice is considered "dispensable".
It stated: "Recent changes to models of care made public by Highland Health Board have suggested that Advanced Nurse Practitioners, an as yet incompletely defined term in primary care, should provide care for patients in the absence of and without the appropriate support of, GPs. Such changes put patient safety at risk."
In 2016, the Scottish Government pledged £3 million to recruit an extra 500 ANPs for the health service. ANPs are registered nurses trained to perform more senior clinical duties. This can include heading up minor injuries units or outpatients clinics in hospitals, or carrying out pre-operative assessments, reducing the workload for consultants and junior doctors. In general practice, they may provide consultations or services for patients with conditions such as depression, rheumatoid arthritis, or heart failure.
The Royal College of Nursing said research into the "safety and effectiveness" of ANPs in primary care "has provided overwhelmingly positive conclusions regarding the value of the role and patient satisfaction".
A spokesman for NHS Highland said ANPs were "highly qualified and experienced nurses" and stressed that the model had already been "tried and tested" successfully in parts of the Highlands.
He added: "GPs are not being replaced. They will always be key to the delivery of primary care. However, GP resource, especially out of hours, is becoming increasingly scarce. This is a well-documented national problem."
RCGP Scotland also criticised ongoing confusion over the share of NHS funding which will be ring-fenced for general practice by 2021. Health Secretary Shona Robison previously said that £250m annually - from a total of £500m for primary care as a whole - would go "in direct support of general practice". However, the College said it was unclear what "in direct support" meant and that the extra cash would take general practice's share of NHS spending to less than nine per cent - lower than England and short of the 11 per cent it has long campaigned for.
It stated: "If the longstanding underfunding and confusion that we are currently experiencing is to continue, we will keep witnessing a considerable number of general practices closing and transferring the running of their practices to health boards due to insufficient resource through which to remain solvent. Patients will continue to be found queuing outside practices for the uncertain opportunity merely to register with a GP."
A spokesman for the Scottish Government said the extra £500m meant that total NHS spending on primary care would equate to 11 per cent of the "frontline NHS budget". He added: “Shona Robison recently set out that £250 million of this new investment will be in direct support of general practice, helping to transform the way services are delivered in the community - an approach that was agreed with the British Medical Association."
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