Nurse Practitioner–Physician Comanagement: A Theoretical Model to Alleviate Primary Care Strain

This is an important paper because it signals the need in healthcare for greater understanding of 'horizontal working' that includes effective communication, mutual respect and a shared philosophy of care. The ever- increasing number of people with long-term conditions and multiple morbidities makes it increasingly important for different practitioners to consider what others do to be equal-but-different, rather than more-or- less-important. Hierarchies in healthcare are often counter-productive.

'Horizontal' mutual respect allows teams and organisations to evolve in ways that make the best of the skills they have. In my practice the nurse practitioners are the GPs and they do the job brilliantly. Medically -trained GPs like myself provide medical backup, but usually the support is the other way around - the nurse practitioners provide backup for me!

This is not simply because the nurse practitioners are extraordinarily skilled; it also comes from cycles of learning and change that help us to know what to expect from each other and explore new ways of doing things. This is what a 'learning organisation' does - essential, in my view, to make the most of comanagement.

Well done the authors.

Competing interests: None declared