Seeing the GP: Advice and tips for young people

When to see a nurse instead of the GP

What is a practice nurse?
Nurses play an important role in providing care in general practice. General practice nurses are nurses that work in GP surgeries. ‘Practice nurses’, as they’re called, are qualified and registered nurses.

A GP talks about when it’s best to see a nurse instead of the GP.

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A GP talks about when it’s best to see a nurse instead of the GP.

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Can you tell us the difference between a practice nurse and a GP and when it’s the best time to see a practice nurse rather than a GP?

Okay, so practice nurses usually have quite specific jobs within the practice. At our practice, our nurses sort out all the immunisations, they do most of the cervical smears. They will do dressings for wounds and things like taking out stitches. And they’ll also see some minor illness but nurses can’t on the whole make diagnosis. And they can’t usually prescribe, so actually that’s deciding whether something needs an antibiotic and giving prescription for that.

Would a patient have to see a GP first before they can see the, a practice nurse or can they see a practice nurse straight away?

No, usually they can see a practice nurse straight away and often receptionists will help someone decide who the best person to see for a particular problem is. So, you know, if actually what you need is travel advice or smoking cessation advice, then the nurse is the person to see. But that’s often why the receptionist will ask what the problem is so that they can direct you to the right person.

What does a practice nurse do?
Practice nurses can help with lots of different health problems. Often they also run clinics for long-term health problems such as asthma or diabetes. Some nurses are nurse practitioners – this means that they have additional training and skills. Some nurses can prescribe medication and are called nurse independent prescribers. Nurses may run clinics for minor problems (such as cuts and ingrown toenails), and most practice nurses carry out cervical screening (smear tests).

Practice nurses can help patients of all ages in many ways including:

• consultations (appointments) in the surgery or health centre

The nurse listened to Simon and advised him about whether he needed to see the doctor that day or not. Simon has juvenile arthritis and Crohn’s disease.

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The nurse listened to Simon and advised him about whether he needed to see the doctor that day or not. Simon has juvenile arthritis and Crohn’s disease.

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So you speak to the reception saying that you want an appointment and if you want one for that day, sometimes they’ve all gone by. It’s quarter to nine when you get through. So they say, “Well, what’s the problem?” So for me that’s not really an issue to say, you know, “I’ve got something wrong with my tummy and a lot of pains. I’ve got Crohn’s. I’m worried that it could be something that needs to be dealt with quickly.” Whereas for some people, you know, they might want, not want to disclose what is wrong really. And I think, you know, they can say to the receptionist, “I don’t wish to disclose that to you.”

But sometimes you might feel that you’re not going to say what is wrong and they might say, “I’ll book them with the nurse.” So once you have told them, “I’m not right. I really need to see somebody.” So they say, “Leave it with us and they’ll be in touch within the next three to four hours.” Sometimes it’s immediately afterwards. Sometimes I’ve to wait, you know, from ringing up at quarter to nine to about twelve o’clock to get a call back. And normally they say, you know, “What’s wrong?” They’ll go through it with you and if they think it’s necessary for you to see a doctor, they’ll say, “We’ve booked you in with an emergency doctor on that day.” But then sometimes they’ve said, “We don’t really think you need to see the GP, what you’re describing. Can you book in perhaps tomorrow or another day for an appointment.”

To see?

Another doctor.

• health checks when people register with a new surgery
• diagnosing and treating minor illnesses

John saw a nurse for an ingrown toenail. She was ‘friendly but efficient’. Treating it was quick and easy but he would have liked a bit more information.

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I think it might have been with a practice nurse maybe. It was a very minor procedure. They just spayed some silver nitrate stuff on the nail or something like that. So it was very quick, and in the open hours they tend to have a lot of people there, so, and they try to keep it moving.

So was that just once you had to go for your toenail?

Yeah, no, I think I went back in for a, just to see that it had sorted itself out.

And was it back again with the nurse?

I can’t really remember.

So you think that you might have seen the nurse rather than the doctor for that?

I definitely saw the nurse for the initial bit, and then I think it was, I imagine it was the nurse for the second bit.

When I went in she [nurse] pretty much just took me into a room, sat me on a, on one of the beds, and took a look at it. And it was all quite friendly but efficient. And then she disappeared off to get some of the stuff to put on my toe to treat it, and it was a bit weird being left in the room on my own, but it was fine. It didn’t bother me too much. And yeah it all seemed quite, it all seemed pretty quick and easy.

Was it painful or was she worried that you might feel some discomfort, or have some side effects afterwards?

It did turn my toe black, which she didn’t really warn me about. But she did warn me about it being a little bit uncomfortable. There was a bit of stinging but it wasn’t too bad.

So would you have liked her to tell you more about the side effects of your toe being black for example?

Yeah, I guess it would have been nice to know. It didn’t really affect anything so I wasn’t too bothered, but it would have been nice to know.

• recording ECGs (heart traces)
• taking blood samples, swabs, specimens, pulses, temperatures and blood pressures

Emma sees the nurse regularly for blood tests and reviews because she has diabetes. The nurse is knowledgeable and answers all her questions.

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I went to see the nurse, well, one, because they do blood tests for our like reviews and stuff for type 1 diabetes. So you don’t need to see the GP for that. So that’s usually just the nurse.

And then also my diabetic review was done by one of the nurses as well. So, yeah, that was, that was fine, completely fine. She had all the information she needed and she was a really, a really nice lady.

Anything they can do to improve the service?

No, not that I can think of. I mean I was, I was fortunate that I had someone who was very knowledgeable, for one. And two, was just very, kind of made sure that I was okay before I left, that all my questions had kind of been answered or, if there was anything else I wanted to talk about. So, yeah, that was a good experience.

• giving vaccinations (injections), and running travel clinics

Hazzan saw a practice nurse to have tetanus, measles, mumps and rubella injections. He’d also seen a school nurse for injections.

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I don’t really go to the GP that often. I think it's only for vaccinations [injections]. But they do do that in our school sometimes, because I don’t really get ill often. But I don’t really see the GP that often, as I got older; I think that as I got older I saw the GP less.

Has it always been the same surgery – like the health centre or GP's surgery – has it always been the same or has it changed over the years?

I've always gone to the same surgery but we have gone to the hospital sometimes if I needed to get a blood test.

So, more recently, it was more to get vaccinations. Can you remember what the vaccinations were for?

I think it was like tetanus and measles, mumps and rubella I think. That’s all I can remember, yeah.

And did you see the GP at those appointments or did you sometimes see a nurse? Who was it usually at the surgery?

It was a nurse. I went to a nurse to go and do it. And the last time I did it, it was with the school nurse. But I did it before that with the nurse at the hospital.

So some injections you had at school?

Hm mm

And was everybody having those that, you know, you all had a time that this afternoon you're having the injection or anything like that?

Yeah, I think that was the case. I think if you'd already gotten them, you didn’t need to go again. Or if your parents didn’t want you to go within the school, you could go and do it with your GP. But I think most of the students went in school.

• providing advice about contraception, fitting contraceptive devices (e.g. the coil), and pregnancy tests

Hannah wanted to have a contraceptive implant but felt the nurse put her off. Hannah felt frustrated, looked online for more information, and then went to a clinic instead.

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There’s just one time I went to the GP because I wanted to have an implant fitted. I can’t remember why the reason, why I wanted an implant then I think because, I think probably I would forget to take my pill quite regularly, which obviously is terrible.
So, so I think I wanted an implant because I think it was sort of I had it, you know, it lasts for however long and I don’t have to remember to do anything. And then when I went to the, I think I saw the nurse actually and she, I think she was like ‘Oh why do you want to have the implant, you know I think you should-,’ I think that she suggested I had the coil and I didn’t want that, I really wanted it, and she said just go away and think about it.

So I left a bit frustrated then because I think, once you have something in your head, you want it done straight away. So I think I left feeling frustrated and, in the end, I didn’t get it, so because I decided it wasn’t the right thing for me so yeah.

Did you look for more information about it?

Yeah, I looked online and I also went to like a clinic, you know, a health, a sexual health clinic and they, the clinic said I could have it. But they didn’t have an appointment for it so I changed my mind at that time anyway, so....

So when you first went you spoke to the nurse at the local surgery. In a way she, she slightly put you off it?

Yeah, definitely.

Then you went home, how long did you think about it and then think ‘no I’ll go to the sexual health clinic’?

Just a few days I think, yeah, cos I think I waited until the clinic had, because they had certain opening times, so I think certain days I think I just waited until, I think I waited like three or four days and then I went to the clinic.

• sexual health services and cervical screening (smear tests)

A nurse carried out Fran’s STI and cervical screening (smear) tests. Fran doesn’t like going to the doctors’ but this nurse was kind, jolly and talkative.

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I’ve been for a few like STI tests and stuff.

And has he [GP] been understanding, you could, do you feel…?

You go to the female. I don’t, I don’t like a man doing STI tests on me. It freaks me out.

So do you go to the nurse in the GP’s surgery?

Yeah.

So you just phone, you would just phone her?

Yeah, I had to have a smear test and stuff. But I don’t go to the doctor’s if I can help it. I don’t like the doctor’s. It’s just cos it reminds me, actually, no, that’s not true. Because I don’t think I’ve ever liked the doctor’s.

So when you’ve gone to see the nurse, has it been different nurses every time or. .

No, it’s usually the same nurse, and she’s really nice as well.

So what makes a good nurse there at the GP’s surgery? Cos you said she’s really nice.

I think it’s just kindness and genuinely being nice to people. It doesn’t hurt. Like you’ve been nice to me today, so I’ve been nice back. It doesn’t hurt to be nice to people.

So it’s just those…?

She’s just a nice person. Like she spends a lot of time going to dance classes and stuff. And she’s just like really into dance and she’s talkative, it’s just nice people, nice person.

So she just talks about normal things as well as what have you come in for, that kind of thing?

She’s really jolly, that nurse. But again I don’t think about her that much, no.

So when you’ve gone in, you’ve gone for things like smear tests, STIs? Does she ask lots of questions or do you feel that…?

Yeah, she just gets on with it, yeah.

And you feel quite comfortable?

Yeah, I like that like attitude, yeah.

Did you ever ask her any questions, did you ever want information about anything? Or do you more or less go there?

Just go and get it over with. I don’t like the doctor’s, even though they’re nice people. It’s not their fault. I just don’t like going to the doctor’s, yeah.

• treating wounds (including when people have self-harmed); applying and removing dressings

Auberon, who’d self-harmed in the past, had seen the nurse a few times for cuts and dressing changes. The nurse was really good and he didn’t feel rushed.

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Have there been any situations where you’ve been able to see the nurse instead of the GP?

Only for cuts and stuff, and for dressing changes but not really, no.

How have the nurses been?

The nurses have been good, really good, yeah.

So really good. Were they understanding?

They were understanding and, yeah, and if you needed they would ask me to see a GP and stuff, yeah.

So did you have a proper time with the nurse, or did you feel all rushed at all or?

I had a proper time with the nurse, because nurse's appointments aren’t time limited, so they're not ten minutes. They're as long as you need really, so which was good.

Shane saw a nurse after he’d self-harmed. She seemed cold. He thought that might have been because she sees so many people with different problems.

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I've seen the nurse on one occasion because of an incident with self-harming in which I was too terrified to go to the hospital when I really should have. So I went to the doctors for that and, when I went to see her, she seemed very, very cold. But that might just be because she has to go through several people of varying severity and circumstances, stuff like that. So I guess that might make you cold-hearted because you don’t know when's the next time you're going to see them and what state they're going to be in, so yeah.

•   providing emergency first aid/treatment
•   giving advice, education and information about health problems, stopping smoking and losing weight
•   ear syringing
•   liaising (working with) with other health professionals, practice nurses, GPs and/or hospitals
•   writing records and keeping patients notes up-to-date