How do GPs' new ways of working affect community nurses? A qualitative study.

Background A growing literature examines the way two changes in primary care - the shift towards remote working, and the diversification of practice teams to incorporate, for instance, physician associates and paramedics - affect patient care within the practice. However, little is known about these changes' effects on community nurses. Aim To explore community nurses' experiences of delivering palliative care in the context of GPs' new ways of working. Design and Setting Qualitative study using focus groups. Method Focus groups were conducted on Zoom with community nurses working in the UK. Data were analysed thematically, using constant comparison. Results Community nurses described extending their roles in palliative care. Alongside pride and satisfaction about this, participants raised several concerns and dissatisfactions, some of which they associated with changes in GPs' ways of working. Two dissatisfactions concerned remote working. First, remote communication with colleagues was seen as creating obstacles to nurses' everyday collaboration with GPs, damaging important working relationships. Second, nurses increased their workload by taking the lead in person-centred care where they saw remote provision by GPs as unsatisfactory. Where workforce diversification led to delegating home visits to paramedics or nurse practitioners, community nurses described feeling a lack of the "GP back-up" that many identified as essential for community palliative care. Conclusion When considering and evaluating interventions that change the way GPs work, policy-makers and commissioners should look not only at consequences affecting primary care teams, but also at effects across the complex ecosystem within which these teams operate.