Emergency Care Practitioners Research Articles

Intraprofessional boundary crossing in acute paediatric care: A rich journey for general practice and paediatric residents.

Achieving optimal collaboration between general practitioners and hospital-based critical care doctors is vital yet challenging, necessitating targeted collaborative training during residency. Despite apparent benefits, implementing intraprofessional learning faces constraints. Understanding its occurrence is crucial for engaging and educating residents. Considering boundaries' learning potential, we developed and evaluated an educational programme for general practitioner (GP) and paediatric (P) residents in paediatric emergency care based on Akkerman's Boundary Crossing Theory. The study investigated how intraprofessional learning mechanisms occurred and what learning conditions facilitated or impeded learning of GP and P residents, aiming to optimise educational programme design for intraprofessional collaboration. We developed an educational programme with three activities: joint medical assessments of paediatric patients in each other's context, mutually mini-Clinical Evaluation Exercises (mini-CEXs) about intraprofessional collaboration skills and educational meetings about collaborative care. We performed a qualitative study with a constructivist approach to explore experiences of the programme. We conducted focus group interviews and analysed mini-CEXs, utilising Boundary Crossing theory for template analysis. Ten GP and eight P residents participated in our study. Learning mechanisms of identification and coordination dominated the joint medical assessments. Mini-CEXs stimulated reflection. Educational meetings with supervisors about intraprofessional barriers initiated transformation. Facilitated learning conditions were bidirectional crossing, enthusiastic supervisors, residents being familiar with each other, clear mini-CEX design and authentic paediatric cases. Unclear mutual expectations during joint medical assessments impeded learning of residents. Working in each other's context triggers learning mechanisms of identification, coordination and reflection, forming the basis for intraprofessional learning in paediatric emergency care for GP and P residents. For development of new collaboration practices, supervisors are necessary to translate reflection into transformation. Mutual responsibilities and expectations should be made more explicit to create a safer intraprofessional learning environment. Our findings extend to other medical training contexts, leveraging boundaries for learning.

Clinical practice guidelines for person-centred handover practices in emergency departments: a scoping review.

To review the available information on clinical practice guidelines for person-centred and current handover practices between emergency care practitioners (ECPs) and healthcare professionals in emergency departments (EDs). Collating existing clinical practice guidelines may improve handover practices. Clinical practice guidelines for person-centred handover practices between ECPs and healthcare professionals in EDs. ECPs transporting and handing patients over to healthcare professionals in EDs. Healthcare professionals including doctors and nurses working in EDs, who are involved in handovers with ECPs. Studies conducted in EDs, emergency rooms or emergency centres in any geographical area. No language or time restrictions were applied. The search included published and unpublished studies, opinion papers as well as primary sources, and evidence synthesis. All qualitative and quantitative research designs were included. The literature on clinical practice guidelines for person-centred handover practices was reviewed. Three electronic databases were searched: MEDLINE (PubMed), CINAHL (EBSCO) and Scopus from inception to May 2023 with no time limits set for the inclusion of published literature in the review. Six guideline organisations were also searched. A data extraction tool was developed, pilot-tested and used to extract data from the included studies. 19 studies met the inclusion criteria. Various mnemonics exist for handover practices. Where mnemonics are not used, participants have identified important information that should be included during handover practices. We did not find any clinical practice guidelines or information on person-centred handover practices in any of the reviewed articles. Currently, there is no gold standard for person-centred handover practices, which has led to various practices being implemented. Currently, there is a paucity of literature on person-centred handover practices. Most articles expressed a need for standardised handover practices; however, not all aspects of handover practices can be standardised and should be kept patient and context-specific. This scoping review protocol was registered on Figshare (10.6084/m9 /m9.figshare.21731528).

Optimising Emergency Care for Older Adults: A Case Study of the EDITH Service Following a Proximal Humerus Fracture

Abstract Background The Emergency Department in the Home (EDITH) service offers emergency Occupational Therapy and medical assessments to older adults at home, thus negating the need for hospital attendances. Mr X, an 86-year-old with vascular dementia and hypertension, sustained a left proximal humerus fracture from a fall. Following assessment in the ED, Mr X was deemed fit for discharge and was referred to EDITH for an acute functional assessment and clinical review. Methods Within 72 hours of discharge, Mr X was visited at home by an Occupational Therapist (OT) and an Advanced Nurse Practitioner (ANP). The OT conducted a home environment assessment, falls-risk screening, delirium screening, reviewed social supports, and performed a functional assessment. Education on one-handed dressing techniques and falls prevention was provided. The ANP conducted a clinical review, and reviewed Mr X’s medication and analgesia. Mr X had the support of his wife to assist with Activities of Daily Living (ADLs), functional mobility and medication management. Mr X’s son purchased assistive equipment recommended by the OT, to enhance home safety. Referrals were made to the local memory support service, a Physiotherapist, and his Public Health Nurse to organise formal care supports. Results Mr X remained at home with support from his wife, primary care services, and virtual EDITH follow-up. Mr X had a scheduled review at the fracture clinic following his ED attendance. Conclusion Emergency care practitioners play a crucial role in addressing acute functional and clinical changes in older adults attending the ED. Supported ED discharges and service integration during the acute phase can prevent hospital admissions. Collaboration between emergency medicine and primary care is essential for addressing acute medical needs and long-term functional outcomes. With adequate social support and timely services, older adults can recover successfully at home.

Reaching consensus on the definition of person-centred handover practices in emergency departments: A modified online Delphi.

To reach consensus on the definition and attributes of 'person-centred handover practices' in emergency departments. Handover practices between emergency care practitioners and healthcare professionals in emergency departments are important and should be conducted meticulously. Person-centred handover practices may enhance the delivery of person-centred care in emergency departments. A three-round online Delphi survey. Nine experts participated in a three round Delphi survey. The expert panel comprised experts from nine countries. Quantitative data were descriptively analysed, and qualitative data were thematically analysed. A consensus of 80% had to be reached before an attribute and definition could be accepted. Experts reached a consensus of 79% in round one, 95% in round two and 95% in round three. A final set of six attributes were agreed upon and the final concept definition was formulated. Person-centred handover practices have not been implemented in emergency departments. Yet, person-centred handover practices may enhance the delivery of person-centred care, which has multiple benefits for patients and healthcare practitioners. Person-centred care is not generally implemented in emergency departments. Person-centred handover practices can lead to person-centred care. Handover practices in emergency departments are a high-risk activity. Despite numerous calls to standardise and improve handover practices, they remain a problem. Developing a standardised definition could be a first step towards implementing person-centred handover practices in emergency departments. The study adhered to the relevant EQUATOR reporting guidelines: Guidance on Conducting and Reporting Delphi Studies (CREDES) checklist. Improve handover practices and patient care. Improve person-centred care in emergency departments. Emergency care practitioners and nurses experienced in handover practices and/or person-centred care, working in clinical and academic fields, participated in the study by sharing their expert knowledge during each of the Delphi rounds.

Public Perception And Social Media Image Of Feldsher in Moscow

Background. Despite being an unnoticed profession, feldsher is often the first point of contact for patients seeking medical assistance. Thus, in order to minimize profession-related risks, it is crucial to study the image of a feldsher, as well as to understand the characteristics and trends of the feldsher image that have emerged in public opinion and the information space.
 Purpose. To identify how Muscovites perceive feldshers and to assess social media coverage of their work.
 Methods. The study used the data collected in telephone surveys conducted among a representative sample of 596 adult Moscow residents. The authors analyzed 1,057 images and conducted content analysis on a subsample of 169,975 social media posts. 
 Results. Collective consciousness mainly perceives the feldsher as an “emergency care practitioner” and a “rural physician” (as a specialist of a rural health post). 21 % of respondents are also unclear about the distinctions between feldshers and doctors or nurses, as well as their place in the medical hierarchy. The results of a quantitative poll are consistent with the social media content analysis about the perception of feldsher's responsibilities. The majority of messages (61 %) are neutral with a slight prevalence of negative (25 %) messages over positive (14 %). Positive messages are more often associated with personal qualities, particularly those that were made evident in dire circumstances during the epidemic, and negative messages are primarily associated with systemic issues of the profession’s status. 
 The color coding of messages is mostly neutral-negative with a predominance of dark, gray, and brown.

Mapping global health activity amongst UK emergency care practitioners: time for a Europe-wide approach?

Mapping global health activity amongst UK emergency care practitioners: time for a Europe-wide approach?

Exposing research misconduct and data misrepresentation targeting nurse practitioners in emergency care

Davis, Wesley D. DNP, ENP-C, FNP-C, AGACNP-BC, CEN, FAANP, FAEN (Family & Emergency Nurse Practitioner Track Coordinator & Assistant Professor)1; Schumann, Lorna PhD, FNP-C, ACNS-BC, ENP-C, FAAN, FAANP (Commission Chair)2; Evans, Dian Dowling PhD, FNP-BC, ENP-C, FAAN, FAANP (Professor Emeritus, Emergency Nurse Practitioner Program)3; Ramirez, Elda PhD, FNP-BC, ENP-C, FAANP, FAEN, FAAN (Professor of Clinical Nursing, Founder)4; Wilbeck, Jennifer DNP, ACNP-BC, FNP-BC, ENP-C, FAANP, FAAN (Emergency Nurse Practitioner Program Director & Professor)6 Author Information

Knowledge, attitudes and practices of emergency care practitioners in the management of common dental emergencies in the eThekwini District, KwaZulu-Natal.

It is essential to provide timeous and appropriate treatment in cases of dental emergencies. First responders such as Emergency Care Practitioners (ECPs) usually provide this prehospital care. The successful management of casualties experiencing common dental emergencies is dependent on two fundamental factors; the first responder's knowledge and ability to render the appropriate level and standard of medical care, and secondly, the time that expires between the onset of the incident and the initiation of definitive emergency medical treatment. Delayed or inappropriate management can have long term physiological and psychological effects.This was an exploratory and descriptive study, using quantitative and qualitative methods to determine the knowledge and attitudes of Emergency Care Practitioners of the eThekwini District of KwaZulu-Natal, South Africa, in the management of dental emergencies.The results revealed that Emergency Care Practitioners had inadequate knowledge, training, and understanding of the management of common dental emeregncies by ECPs. There was limited initial training, with a significant portion of the participants (44.9%, p 0.233) having not received any training at all in the management of orofacial traumas, and with a significant majority (78.3%, < 0.001) having no further education and training. Most ECPs indicated a desire to receive such training. This study indicated that ECPs lacked confidence in managing dental emergencies, which highlighted a need for specific dental awareness and training programs to further empower ECPs in the management of such emergencies.

Do Perceptions about Palliative Care Affect Emergency Decisions of Health Personnel for Patients with Advanced Dementia?

Decision analysis regarding emergency medical treatment in patients with advanced dementia has seldom been investigated. We aimed to examine the preferred medical treatment in emergency situations for patients with advanced dementia and its association with perceptions of palliative care. We conducted a survey of 159 physicians and 156 nurses from medical and surgical wards in two tertiary hospitals. The questionnaire included two case scenarios of patients with advanced dementia presenting gastrointestinal bleeding (scenario I) or pneumonia (scenario II) with a list of possible interventions and 11 items probing perceptions towards palliative care. Low burden interventions such as laboratory tests and intravenous administration of antibiotics/blood were preferred. Palliative measures such as analgesia/sedation were chosen by about half of the participants and invasive intervention by 41.6% (gastroscopy in scenario I) and 37.1% (intubation/mechanical ventilation in scenario II). Medical ward staff had a more palliative approach than surgical ward staff in scenario I, and senior staff had a more palliative approach than junior staff in scenario II. Most participants (90.4%) agreed that palliative care was appropriate for patients with advanced dementia. Stress in caring for patients with advanced dementia was reported by 24.5% of participants; 33.1% admitted fear of lawsuit, 33.8% were concerned about senior-level responses, and 69.7% were apprehensive of family members’ reaction to palliative care. Perceptions of health care workers towards palliative care were associated with preferred treatment choice for patients with advanced dementia, mainly in scenario II. Attitudes and apprehensions regarding palliative care in these situations may explain the gap between positive attitudes towards palliative care and the chosen treatment approach. Acquainting emergency care practitioners with the benefits of palliative care may impact their decisions when treating this population.

Implementing an entrustable professional activities programmatic assessments for nurse practitioner training in emergency care: A pilot study

BackgroundEntrustable professional activities (EPAs), as new methods used to operationalize competency-based education, are gaining acceptance in medical professions. However, no EPA-based framework exists to evaluate emergency care nurse practitioners' competencies in clinical practice. ObjectivesTo develop, implement, and evaluate an EPA-based framework for emergency care nurse practitioners. DesignProspective observational study. SettingAn accredited nurse practitioner training program in the emergency department of a University-affiliated Hospital. ParticipantsEight novice nurse practitioners and eighteen clinical instructors. MethodsA working group of academic educators, nurse practitioner leaders, and clinical instructors developed a set of EPAs using a participatory design method. We scheduled weekly ad hoc evaluations for the nurse practitioners in emergency care, and we collected several observations from multiple assessors for analysis. ResultsFour nested EPAs were developed that adopted a 1–5 supervision–entrustment scale to measure performance. The results of the 20-month assessments illustrated that the average scores of EPA1, which measured the assessment and management of patients with acute medical presentations in the emergency department, differed significantly but were not positively correlated with the nurse practitioners' increasing subspecialty and department seniority levels (Kruskal–Wallis test P = .011 and 0.006, respectively). In addition, the most time required for the nurse practitioners to achieve a stable level 5 entrustability score for all EPAs for at least 3 consecutive months was 18 months. Clinical instructors noted that recognizing limits is a skill that is essential for a nurse practitioner to earn clinical instructors' trust. ConclusionsEntrustability scores may not correlate with nurse practitioners' increasing seniority, and patient care requires the longest training time (18 months) for emergency care nurse practitioners to achieve autonomy. Program directors should adjust the supervision–entrustment level expected at various stages of training according to the complexity of individual EPAs. An EPA-based assessment framework in a nurse practitioner training program may assist in overseeing the development of competencies for emergency care nurse practitioners.

A comparison of the content taught in critical care transportation modules across South African bachelor's degrees in emergency medical care.

Background and objective Critical care transport (CCT) involves the movement of critically ill patients between healthcare facilities. South Africa (SA), like other low- to middle-income countries, has a relative shortage of ICU beds, making CCT an inevitability. In SA, CCTs are mostly done by emergency care practitioners; however, it is unclear how universities offering Bachelor in Emergency Medical Care (BEMC) courses approach their teaching in critical care and whether the content taught is consistent between institutions. In our study we formally evaluate and compare the intensive and critical care transport modules offered at SA universities in their BEMC programmes. Methods The electronic version of curricula of the critical care transport modules from higher education institutes in SA offering the BEMC were subjected to document analysis. Qualitative (inductive content analysis) and quantitative (descriptive analysis) methods were used to describe and compare the different components of the curriculum. Curricula were assigned into components and sub-components according to accepted definitions of curricula. The components included: aims, goals, composition and objectives of the course; content or teaching material and work-integrated learning. Results The four universities that offer BEMC programmes were invited to participate, and three (75%) consented and provided data. The duration of the modules ranged from 6 to 12 months, corresponding with notional hours of 120 - 150. A total of 83 learning domains were generated from the coding process. These domains included content on mechanical ventilation, patient monitoring, arterial blood gases, infusions and fluid balance, and patient preparation and transfer. Two universities had identical structures and learning outcomes, while one had a different structure and outcomes; it corresponded with a 58% similarity. Clinical placements were in critical and emergency care units, operating theatres and prehospital clinical services. Conclusion In all components compared, the universities offering BEMC were more similar than they were different. It is unclear whether the components taught are relevant to the SA patient population and healthcare system context, or whether students are adequately prepared for clinical practice. Postgraduate educational programmes might need to be developed to equip emergency care practitioners to function in this environment safely. Contributions of the study Owing to the limited availability of ICU beds in South Africa, optimising and standardising critical care transport is an important consideration. This study identifies important elements for improving emergency medical care training in South Africa, as well as areas needing further research.

Human errors and factors that influence patient safety in the pre-hospital emergency care setting: Perspectives of South African emergency care practitioners.

BackgroundDelivering pre-hospital emergency care has the potential to be hazardous. Despite this, little is known about the factors that precipitate human errors and influence patient safety in the pre-hospital care setting, in contrast to in-hospital care. Similarly, limited report on patient safety and human error issues in the pre-hospital emergency care setting exist in South Africa.AimThis study investigated the perspectives of emergency care personnel (ECP) in South Africa on the types of human errors and factors that precipitate human errors that influence patient safety in the pre-hospital emergency care setting in South Africa.SettingThis study was conducted in the pre-hospital emergency care environment in South Africa.MethodsThis research was designed as an exploratory study that made use of a semi-structured questionnaire administered to 2,000 emergency care personnel.ResultsA response rate of 76% was obtained. According to the participants, errors relating to poor judgement, poor skill or knowledge, fatigue, and communication, and individual error are common during pre-hospital care. Inadequate equipment, environmental factors, and personal safety concerns were reported as some of the factors that influence patient safety in the pre-hospital emergency care setting.ConclusionImplementation of strategies that enhances education and training, clinical skill development, teamwork skills, fatigue management, and leadership skills can help prevent some of the errors identified in this study.ContributionThis study identifies the types of human errors, and factors that precipitate human errors that influence patient safety in the pre-hospital emergency care setting in South Africa.

Emergency care practitioners’ views on the use of ultrasound in pre-hospital acute care settings

Background: Ultrasound may assist in the detection of life-threatening conditions and evolving pathologies. South African emergency care practitioners (ECPs) working in pre-hospital contexts have historically not used ultrasound to diagnose and treat patients. However, recently published clinical practice guidelines from the Health Professions Council of South Africa (HPCSA) suggest that ultrasound be considered as an adjunct in the provision of pre-hospital emergency care. Our study investigated ECPs’ views and perceptions of introducing ultrasound to their scope of practice.

Simulated clinical scenarios: The experiences of Emergency Care Practitioner students

Background: Simulation education as a strategy is used extensively in Emergency Medical Care Departments. The literature in this field strongly suggests positive effects on patient safety and student-readiness. Simulation education strategies often fail to address the student experiences in the classroom. The aim of this study was to explore how Emergency Care Practitioner (ECP) students experience simulated clinical scenarios. Methods: This study was conducted at a South African University in the Gauteng province. Data was collected through semi-structured interviews. Convenience sampling was used to recruit participation. Data saturation occurred after six interviews. Open coding was used to code the transcripts. Results: ECP students experienced simulated clinical scenarios to be a highly beneficial teaching and learning experience, but experienced simulation as a nerve-racking assessment tool that requires excellent debriefing and feedback to improve its effectiveness. High-fidelity simulation scenarios, that are built on real-life context, are received most favourably by students. Conclusions: ECP Students find simulated clinical scenarios to be valuable in their education. To achieve a favourable simulation experience for ECP students excellent debriefing and feedback protocols need to be implemented. Availability of time to practise in the simulation laboratory is limited and students feel limited by this.

Emergency care practitioners’ knowledge, preparedness and experiences of managing COVID-19 in Australia

Introduction: Emergency care practitioners play a crucial role during public health emergencies and have been at the frontline during the COVID-19 pandemic. This study examines the knowledge, preparedness and experiences of emergency nurses, emergency physicians and paramedics in managing COVID-19 in Australian healthcare settings.

Rapid sequence intubation: a survey of current practice in the South African pre-hospital setting

BackgroundRapid sequence intubation (RSI) is an advanced airway skill commonly performed in the pre-hospital setting globally. In South Africa, pre-hospital RSI was first approved for non-physician providers by the Health Professions Council of South Africa in 2009 and introduced as part of the scope of practice of degree qualified Emergency Care Practitioners (ECPs) only. The research study aimed to investigate and describe, based on the components of the minimum standards of pre-hospital RSI in South Africa, specific areas of interest related to current pre-hospital RSI practice.MethodsAn online descriptive cross-sectional survey was conducted amongst operational ECPs in the pre-hospital setting of South Africa, using convenience and snowball sampling strategies.ResultsA total of 87 participants agreed to partake. Eleven (12.6%) incomplete survey responses were excluded while 76 (87.4%) were included in the data analysis. The survey response rate could not be calculated. Most participants were operational in Gauteng (n = 27, 35.5%) and the Western Cape (n = 25, 32.9%). Overall participants reported that their education and training were perceived as being of good quality. The majority of participants (n = 69, 90.8%) did not participate in an internship programme before commencing duties as an independent practitioner. Most RSI and post-intubation equipment were reported to be available; however, our results found that introducer stylets and/or bougies and end-tidal carbon dioxide devices are not available to some participants. Only 50 (65.8%) participants reported the existence of a clinical governance system within their organisation. Furthermore, our results indicate a lack of clinical feedback, deficiency of an RSI database, infrequent clinical review meetings and a shortage of formal consultation frameworks.ConclusionThe practice of safe and effective pre-hospital RSI, performed by non-physician providers or ECPs, relies on comprehensive implementation and adherence to all the components of the minimum standards. Although there is largely an apparent alignment with the minimum standards, recurrent revision of practice needs to occur to ensure alignment with recommendations. Additionally, some areas may benefit from further research to improve current practice.

"I still feel so lost": experiences of women receiving SANE care during the year after sexual assault.

ObjectiveEmergency caregivers provide initial care to women sexual assault (SA) survivors. An improved understanding of the issues facing this population can aide emergency care practitioners in providing high quality care. The goal of this study was to share the experiences of women SA survivors with the emergency care practitioners that care for them.MethodsEnglish‐speaking adult women (n = 706) who received SA Nurse Examiner (SANE) evaluation within 72 hours of SA at 1 of 13 geographically distributed sites were enrolled in a prospective, longitudinal multi‐site observational study. We qualitatively analyzed responses to the open‐ended question: “What do you think is most important for researchers to understand about your experience since the assault?” asked 1 week, 6 weeks, 6 months, and 1 year after enrollment.ResultsThemes from responses (n = 1434) from 590 women (84% of study sample) fell into 12 broad categories: daily life, justice, medical, and social services, mental health, physical health, prior trauma, recovery, romantic relationships, safety, self, shame, and social interactions. Responses demonstrated that the assault permeates many aspects of assault survivors’ daily lives.ConclusionsQualitative analyses of open‐ended responses from a large cohort of women SA survivors receiving SANE care highlight the challenges for survivors and can increase understanding among the emergency care practitioners who care for them. The authors propose a brief acronym to help emergency care practitioners recall important messages for SA survivors.

Doctors', nurses' and clinical associates' understanding of emergency care practitioners.

BackgroundHealthcare professionals’ understanding of the knowledge, skills and training of their counterparts from other disciplines cultivates appreciation and respect within the workplace. This, in turn, results in better teamwork and improved patient care. Emergency departments are places where emergency care practitioners (ECPs) engage with doctors, nurses and clinical associates. Whilst the importance of inter-professional communication and teamwork between in-hospital professionals and pre-hospital emergency care providers is acknowledged, no literature could be found describing exactly how much these in-hospital professionals understand about the training and capabilities of their ECP colleagues.AimThe aim of this study was to assess the level of understanding that prospective doctors, nurses and clinical associates have regarding the training and capabilities of ECPs.SettingThe research was conducted in Johannesburg, South Africa, at two universities.MethodsSeventy-seven participants completed a purpose-designed questionnaire assessing their understanding regarding the education and clinical capabilities of ECPs.ResultsIn total, 64% of participants demonstrated a poor understanding of the level of education and clinical capabilities of ECPs. The remaining 36% showed only moderate levels of understanding.ConclusionMedical, nursing and clinical associate graduates have a generally poor understanding of the education and clinical capabilities of their ECP colleagues who practise predominantly in the pre-hospital environment. This lack of understanding can become a barrier to effective communication between ECPs and in-hospital staff during patient handover in emergency departments.ContributionThis research highlights a lack of understanding about the role and function of South African ECPs as pre-hospital emergency care providers and the need for more effective inter-professional education.

Life as a locum

Most health professionals are likely to weigh up the pros and cons of becoming a locum at some point in their careers. The prospect of being able to choose where and when you do or do not work is often a big pull. In this first instalment of the JPP Paramedic Roles column, Suki Kaur, who has been a paramedic since 2013, explores why she decided to become a locum emergency care practitioner 3 years ago.

Future-proofing the primary care workforce: A qualitative study of home visits by emergency care practitioners in the UK

Background Broadening the skill-mix in general practice is advocated to build resilience into the primary care workforce. However, there is little understanding of how extended-scope practitioners from different disciplines, such as paramedicine and nursing, embed into roles traditionally ascribed to general practitioners (GPs). Objectives This study sought to explore patients' and professionals' experiences of a primary care home visiting service delivered by emergency care practitioners (ECPs), in place of GPs; to determine positive impacts/unintended consequences and establish whether interdisciplinary working was achieved. Methods Three practices in England piloted an ECP (extended-scope practitioners with a paramedic or nursing background) home visiting service (November 2018–March 2019). Following the pilot, focus groups were conducted with each of the three primary healthcare teams (14 participants, including eight GPs), and one with ECPs (five participants) and nine individual patient interviews. Data were analysed using a modified framework approach. Results The impact of ECP home visiting on GP workload and patient care was perceived as positive by patients, GPs and ECPs. Initial preconceptions of GPs and patients about the ECP role and expertise, and reservations about the appropriacy of ECPs for home visiting, were perceived to have been overcome by the expertise and interpersonal skills of ECPs. Fostering a culture of collaboration between ECPs and GPs was instrumental to remodelling professional boundaries at the practice level. Conclusion Broadening the skill-mix to incorporate extended-scope practitioners such as ECPs, to deliver primary care home visiting, presents an opportunity to increase resilience in the general practice workforce.