We may be invisible as advanced nurse practitioners (ANPs) in general practice but I would argue that this is because we fit seamlessly into this clinical area and many others.
Physician Associates (PA) see patients under strict GP-led protocols and are not supposed to work autonomously. In my role as an ANP, I see and deal with everything from compression bandaging to child immunisation, recognise and refer on (as necessary) a purpuric rash and organise the complex medication reviews for patients with long-term conditions. These things are the norm – who else do you know that can do that?
Ghislaine Young mentions lack of regulation. Oh dear, here we go again. The RCN and NMC have been dragging their feet on this one since the introduction of Nurse Prescribers (NPs) in, good heavens, was it 1985?
Scant guidelines, not a register for NPs and ANPs, effectively means that anybody can call themselves an NP or ANP and some will do so erroneously.
Some influential GPs who have perhaps suffered because of this lack of regulation are not keen on the ANP role and might be setting opinions in this area.
PAs have no regulatory body so have to work strictly to a protocol – on a recent immunisation course of mine, one had to work to patient specific direction (asking an independent prescriber before she vaccinated each and every patient) because she could not use a patient group direction (PGD) like registered nurses and so could only give immunisations in a similar way to a healthcare assistant.
PAs are not a knee-jerk reaction but will not fill the gap of the ANPs or GPNs who have nursing and public health in their blood. ANPs, as Ghislaine says, bring the 'alchemy' of medicine and nursing into general practice.
There is a crisis around staffing in the NHS and if we are keep to patients out of hospital and manage them in the community, we need more staff – and do not get me started on the seven-day NHS. Great idea but where are the resources?
ANPs have a fantastic career pathway too – if you need someone to insert sub-dermal implants, do your cautery clinics or fit intrauterine contraceptive devices, your ANP can be trained to do this with a minimal amount of fuss. Generally, ANPs will work autonomously assessing, treating, medicating and discharging patients – can and would the PA do the same? Additionally ANPs will bring to their roles previous experience – in my case, practice nursing skills.
Having taught a family and child module to PAs for several years, I am well aware of the training and capabilities of PAs.
I would suggest as ANPs we are not invisible but a perfect fit around the doctors who are the backbone of general practice. Many GPs and CCGs are aware of the potential of ANPs and a recent CQC audit of a nurse-led practice deemed it 'outstanding'. We need to celebrate that with one and all.
Kirsty Armstrong, senior lecturer/practitioner in primary, Kingston University and St George's Hospital, London