NP Clinic – when you need a ‘Dr’ ?

The importance of collaborative practice is no more important than when running a NP led general practice! Ideally I’d have one ‘on tap’ in times of need, however that need is very varied and not all day every day, so I’ve had to find innovative ways of  working this, to benefit the patient and ensure no unnecessary delays in diagnosis, assessment or treatment of a patient.The local “Health Pathways” are a reliable and important starting point. 

SO how do I do this…?  Firstly it depends on the situation and the urgency of the presenting complaint. For the acutely unwell person this is actually easier. The answer, irrespective of who sees the patient (NP or GP) is that they need further investigations that cannot be done in General Practice and so must go to the emergency department at the local hospital (20+ mins away).

It is the non- urgent presentation that would often benefit from the second opinion for the “ideal” outcome for both patient and clinician. For example, a lesion, a rash, medication, de-prescribing, pain relief in certain patients, a non specific pain, a vague history that means you wonder if you are missing something… and there are many others! SO if I’m very concerned, but this is not an “emergency department” case I will “phone a friend”.

That might be a pharmacist, general physician, a orthopaedic surgeon, a physio, a geriatrician, the pain clinic, the clinical nurse specialists in respiratory, cardiology or mental health … and so on.  This works incredibly well.  There are also local GP(s) in the area who have offered to be available for me if I want to phone them with a situation that I want to discuss.

If the situation can afford to wait, then they may be booked in to see the GP in the next GP clinic.  If it’s an opinion only that I want, I will either send through a task to the GP and ask the question, or when I am in the clinic on the same day as the GP, these are the cases I will discuss. This system seems to work.  I can also write and ask for “advice only”  from secondary care, through the electronic referral system.  This can take a few days to a week, so it is only appropriate for some issues.