The Clinical Nurse Specialist as the Manager of the Family Medicine Clinic: A Hybrid Solution Between Four Major Commonwealth Realms.

There exist several interconnected issues that hinder the development of family medicine in Commonwealth realms such as the United Kingdom, Canada, New Zealand, and Australia. These issues affect both the medical and nursing professions. Family physicians, in most countries including the United Kingdom, are not considered "specialists" and are called "general practitioners" instead. The term GP is an outdated and potentially demeaning term relegated to the early 20th century when they did not receive any more than a few rotations as staff grades before being allowed to run their own community clinic. Registered nurses often cover a minor and subaltern role when working as practice nurses in the UK. They are often replaced by cost-effective, licensed practical nurses in most other English-speaking countries. Nurse practitioners in the UK, though being de facto entirely equal to family physicians in countries like Canada, Australia, New Zealand, and most US states, do not hold a special registration status. Their training is not defined in specific legislation, and they do not function as alternatives to general practitioners in the sense that patient may register with them alone which is often the case in Canada or the USA. Family medicine is, therefore, generally left lacking leadership with members of the medical and nursing professions often struggling for "power" in a way that undermines the foundation of family medicine which is to serve the health needs of a large population ranging from children to seniors. The purpose of this paper is to describe a solution to management in a Family Medicine Clinic in Calgary, Alberta, Canada. In this model, the physician-nurse team developed a highly trained role of Clinical Nurse Specialist which serves as an overall clinic manager. The implementation of the Clinical Nurse Specialist-led model in family medicine has improved clinic efficiency, patient access, and provider satisfaction. This approach demonstrates a viable framework for enhancing primary care management across Commonwealth realms.