The Advanced Practitioner in Primary Care Dr Deborah Atkinson MSc BSc(hons) RN

Overview- the role Drivers Challenges Case study

Overview  Role development over the past years  2002 first RCN guidance on NP role  2008 RCN Advanced Nurse Practitioner competency document  2010 DH position statement  2011 ANP growth across all sectors

Workforce for the 21st century  Reduced numbers of junior doctors/time  Increased acute care demand  EWTD  Pressure on hospital capacity

Things have come a long way....

Unprecedented demand on Emergency departments….. Jeremy Hunt: 'I took my children to A&E because I didn't want to wait for GP appointment'

…But what about the demand on General Practice?... Dr Maureen Baker, Chair of the Royal College of GPs, said: “Everyone is talking about the crisis in Emergency Departments but the explosion in demand for general practice is being ignored.”

Contributory factors  Increasing and aging population  More complex and long term conditions  Reduced funding in Primary care and general practice  Lack of long term planning and investment

General Practice The bedrock of the NHS General practice central to vision for the NHS 8-8, 7 day access to GP appointments GP recruitment problem Out of Hours provision challenging Sustainability Affordability

Introduction to the Advanced Nurse Practitioner (ANP) role  UK- since approx  Clinical Masters degree  Clinical examination and diagnostic skills  V300 Independent Prescriber qualification  Able to communicate and negotiate at all levels  Problem solving, initiative, autonomous, multi-tasking

Cochrane Review Substitution of doctors by nurses in primary care (Laurent, Reeves & Hermens et al; 2005)  Nurses and doctors generate similar short term health outcomes for patients  Patient satisfaction was higher when nurses provided first contact care  Patient satisfaction was higher for nurse led care in chronic disease management

 Nurse consultation lengths tended to be higher  Nurses tended to recall patients more frequently  Prescribing practices were similar between doctors and nurses  No significant reductions in cost

Not regulated Prescribing qualification Slow growth in available roles Confusing titles MSc courses- variation Lack of knowledge regarding ANP role

Case study-  ‘Out of hours’ provider  Urgent care- ‘Out of hospital’  General Practice  Triage for same day appointment  Face to face  Home visits

Advanced Practitioners at Mastercall  Team of approx 20 ANPs  Expanding numbers  Backgrounds in primary and secondary care, acute/medical/surgical/renal  Growth in the role-  clinician advice  Face to face consultations treatment centre  Home visit  Verification of death

Average Consultation Length (Mean)

WIC Activity- Unregistered patients

Referral to ED outcome comparison

Limitations of the role  Mental Health presentations  Obstetrics  Infants <12months  Additional skills may be needed  Paediatrics  Gynaecology

Conclusion ANPs may support GP and nursing workforce Sustainability 2 year part time study at University Flexible Generic skill set Further research needed

Thank you