1. Using Advanced Clinical Practitioners to address the workforce crisis in the General Practice setting: a coal-face view of opportunities and challenges
Joanne Reeve
Ian Brown*, Chris Burton*, Ben Jackson*, Julie Perrin**
* Sheffield ** HEE-SY ACP Faculty

2. A changing primary care workforce:
Rapid scoping review of introduction of ACPs in SY&B

3. A report to NHSE: describing implementation
Led by Ian Brown
8 recommendations for GPN workforce plan
Based on which NHSE commissioned Skills for Health to develop ANP/ACP core competencies framework

4. Secondary analysis: explaining implementation
RQ: Can a secondary analysis offer additional insights?
Data: mixed data set: rapid review of policy, training & recruitment, workforce numbers analysis, focus groups with students, practitioners and patients
Analysis: thematic analysis, Normalisation Process Theory (May 2009) inc the NPT toolkit (
Work in progress…

5. Introducing Normalisation Process Theory
Understanding the dynamic processes of implementation and integration – how innovation becomes embedded into every day practice
Theory predicts work in 4 domains necessary to embed new intervention in practice:
* Sense making * Engagement * Action * Monitoring

6. AMBIGUITY & FIT FOR PURPOSE TENSION - TRAINING or SERVICE PROVISION
Thematic Analysis
NECESSARY
ENGAGEMENT
AMBIGUITY & FIT FOR PURPOSE
TENSION - TRAINING or SERVICE PROVISION
MORE THAN A MASTERS
UNINTENDED CONSEQUENCES

7. NPT Toolkit Analysis ACP different from current ways of working
Mostly Yes, except ANPs
Collectively agree purpose of ACP
AMBIGUITY
Individually agree purpose of ACP
Ambiguity, esp training vs service prov
See potential value of ACP
Yes (shared view?)
Key people drive ACP
Yes, especially in large, training practices
All agree to principle of ACP
Ambiguity
All buy in to doing the work
Mixed
All continue to support ACP
Doubts on sustainability

8. NPT Analysis People perform the tasks of ACP Mixed
Work helps maintain trust within teams
No structure to support
Work appropriately allocated
Data does not support this
Work adequately supported
People access info about effects No
Collective assessment: is worth it
Probably yes
Individual assessment: is worth it
Modify/adapt work in response to ACP
No (not yet)

9. Conclusions and questions arising…
Implementation or Conceptual Problem?
Utility of Secondary analysis?
Theory (not just “evidence”) informed change…Generating Knowledge-in-Pactice- in-Context (Gabbay 2009) implications for research?