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

2. Overview- the role Drivers Challenges Case study

3. Overview  Role development over the past 25-30 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

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

5. Things have come a long way....

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

7. …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.”

8. 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

9. 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

10. Introduction to the Advanced Nurse Practitioner (ANP) role  UK- since approx. 1980  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

11. 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

12.  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

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

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

15. 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

16. Average Consultation Length (Mean)

17. WIC Activity- Unregistered patients

18. Referral to ED outcome comparison

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

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

21. Thank you