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The Advanced Practitioner in Primary Care

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 25-30 years 2002 first RCN guidance on NP role 2008 RCN Advanced Nurse Practitioner competency document

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The Advanced Practitioner in Primary Care

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

  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 ReviewSubstitution 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. Thankyou

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