'Crossing professional boundaries': barriers to the integration of nurse practitioners in primary care

The aim of this study was to explore, through qualitative research, how health professionals perceive the current and potential role of nurse practitioners in primary care within the Southampton City Primary Care Trust (SCPCT). Qualitative research methods were used, informed by grounded theory, using semi-structured interviews. A total of 21 interviews with nurse practitioners, general practitioners (GPs), practice nurses and managers were tape recorded, transcribed by the researcher and analysed through constant comparison. Five centres were recruited using purposive sampling to achieve breadth and depth of experience of the nurse practitioner role. The centres were from different geographic and demographic localities in SCPCT and also included a variety of models of primary care delivery: GMS (General Medical Services), PMS (Personal Medical Services) and walk-in-centres, to reflect the different contexts and service structures within which nurse practitioners work. Themes were identified from the data in four areas: the drivers for the nurse practitioner role, the current nurse practitioner role, the barriers to the nurse practitioner role and the potential future nurse practitioner role. This paper will focus on the key theme that emerged of barriers to the nurse practitioner role. These were identified as organisational factors, training and prescribing issues, lack of a professional register and cultural issues, including tensions, boundaries and responsibility. The future for nurse practitioners in general practice is uncertain because there are considerable practical and cultural barriers. To promote the integration of nurse practitioners these barriers need to be addressed.