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In the 75 years since the foundation of the British Society of Gastroenterology (BSG), one of the major changes in the care of patients with gastrointestinal disorders has been the emergence of the role of specialist nurses. Three-quarters of a century ago nurses were still very much in the ‘handmaiden to doctors’ role, carrying out medical instructions and keeping patients clean and tidy. This has now been transformed, in the UK at least, into a range of nurse-led services managed by nurses who, with appropriate training, can prescribe all licensed medications (on completion of a separate qualification that is registered nationally), order and conduct the full range of investigations and often manage whole episodes of specialist hospital care without patients ever seeing a doctor at all. Even compared with a decade ago,1 2 there has been a rapid expansion in both the scope of practice and in the number of nurses involved.
This has often been driven by organisational and financial constraints. As the UK has salaried healthcare professionals and a national health service, the competition between professionals that has arisen in systems in which loss of a patient consultation equates to loss of income, has not generally arisen. Doctors have usually been more than happy to cooperate in training nurses to take over the more routine aspects of medical care. This, together with a European working time directive that has restricted junior doctors' hours, has seen a huge expansion of the scope of nursing practice in gastroenterology and elsewhere in the health economy. Nurses (in non-gastroenterology care) have been found often to be cheaper than doctors, even if they take longer with each patient and order more investigations, and to be no less effective clinically in consultations.3 Often patient satisfaction is higher with nurses.4 5
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