Advanced Nurse Practitioners impact across Primary Care

Abstract

Primary Care in an Integrated System: NHS Lanarkshire has recognised the need to redesign general practice to ensure its services meet the health needs of the people of Lanarkshire now and in the future. Our innovative Primary Care and Mental Health Transformation Programme PCMHTP is a major improvement programme that aims to improve patient access to general medical practice in Lanarkshire. The Lanarkshire approach to transforming primary care got underway 18months ago and is reflected in the recent proposal for the new Scotland-only GP contract. General Practice and Community Redesign work stream of this programme is exploring how an advanced practice, multi-disciplinary team MDT approach improves access for patients to health services in the community , maximising the contribution of all health and social care professionals in delivering the ‘right person, first time’ outcome for patients. This work includes a team of nine trainee Advanced Nurse Practitioners ANPs recruited by NHS Lanarkshire to support primary care. ANPs are highly experienced nurses who are working towards completing a competency framework that will support and evidence their learning in Advanced Nursing Practice. The trainee ANPs are currently enhancing their clinical skill set, and are supported in developing their clinical skills by General Practitioners GPs, whilst undertaking Masters level study in Advanced Clinical Practice. The aim of the project is to develop the team in order to test and evidence how they can support MDTs as a resource for supporting complex care delivery, releasing time for GPs to focus on care delivery as the lead clinicians in primary care. The project is utilising quality improvement methodology in testing and developing the approach and has a comprehensive set of evidence data. ANPs are currently being supported within out-of-hours primary care centres and general, testing how they can best support an MDT approach to patient care in community hospitals and care homes. ANPs will be able to assess life-span as generic practitioners with advanced clinical assessment skills, and prescribing qualification. Following further development they will have full access to diagnostics to enable them to manage the full clinical care of the individual requiring assessment of health needs. The development of ANPs in primary care in Lanarkshire is demonstrating the considerable impact they can make as part of a multi-disciplinary team, and supported by the Scottish Government’s commitment to invest in training an additional 500 ANP’s by 2021. The ANPs are developing in key areas of practice through leadership, facilitating change and improvement in patient experience creating better easier access to GP’s. Through the ANPs leading on research within their areas, they are building up an evidence base that provides confirmation of improved patient experience and quality person-centred care across all age groups. Whilst learning and developing as a new service within NHS Lanarkshire, the team members have a clear governance structure that supports their clinical practice and identifies limitations of practice. The team are developing as a sought-after resource to support person centred care delivery in general practice as autonomous practitioners in the near future.