“Nurses could and should assume roles traditionally held by General Practitioners. The issue of ‘role substitution’ in the local scenario needs to be further discussed.” This was stated by Parliamentary Secretary for the Elderly and Community Care, Mario Galea, during his closing speech of the 6th Primary Health Conference entitled Developing Nursing Roles in Primary Health Centre Care.

Galea called for the extension and development of the nurse’s role, which may include, amongst others, work traditionally carried out by the doctor. He argued that the need for these developments is an issue that we can no longer ignore. “Furthermore this issue is crucial to any restructuring process which needs to be implemented.”

The Parliamentary Secretary remarked that in the local context, “the role of nurses working in the Primary Health Care sector is limited. Patient assessments and related decision making are mostly within the role of GPs”. Mario Galea noticed that there were “developments in this area, such as the establishment of the ‘Health Awareness Clinics’ where health needs assessments are carried out by nurses. However, decision making, central to these assessments, such as those related to screening tests, are still within the role of the GP.”

Galea said that he believes that the need for further nursing developments in the Primary Health Care sector can no longer wait. Ways by which these developments could best be implemented need to be studied, taking into account the foreign context.

The Parliamentary Secretary argued that “such a move implies first and foremost a cultural change.” He added that “our nurses are academically and clinically prepared to assume more specialized and autonomous roles. Yet they also need to be psychologically prepared to assume such roles. The general public should also be prepared and assured to accept the fact that they will be cared for by nurses. It is thus imperative that such a change needs to be well planned and most importantly it needs to be done gradually.”

Galea referred to the World Health Organization (1998) document ‘Family Health Nursing’. Nurses within this role provide counselling, support and home care to a limited number of families. A good step towards this direction has been the establishment of the CommCare unit, whereby nurses visit and assess patients in the community, identify needs and perform the required referrals and follow up. These nurses now form part of a multidisciplinary team which aims at giving integrated, holistic care to patients.

Galea pointed out that he had “recently set up an Elderly Community Outreach Team, its aim is to support the Elderly in the community. It is composed of a Multi Disciplinary Team.”

Parliamentary Secretary Mario Galea concluded by acknowledging “that the implementation of extended nursing roles may seem challenging. Yet this should be the way forward to ensure accessible and affordable good quality care, allowing GPs and specialists more time to dedicate to more complicated and specialized care.”

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