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Answering the correct question

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The ANP workforce should be developed The ANP workforce should be developed

New ways of working and innovation are essential to the health service. As clinicians, we all want what is best for our patients, families and carers and it may be that physician associates in general practice are the way forward, because they best meet the current clinical need.

However, I believe that we are at risk of ‘answering the wrong exam question’, or at the very least at risk of missing an exam question about the fantastic skills of nurses and their potential to meet the need for clinicians in primary care.

In the north west of England, a postgraduate diploma preparing students to become a physician associate in two years is now open for applicants. The University of Manchester website offers the following description: ‘Physician associates are permanent members of the medical team and perform physical examinations, order and interpret diagnostic tests, and recommend therapy.’

It is significant that a physician associate will not be able to prescribe, despite the physical examination skills and the interpretation of diagnostic tests – and yet nurses can become qualified as advanced nurse practitioners and can then undertake the whole spectrum of this work.

It is also noteworthy that the students – with 65 places available - will not be charged a course fee and they will be paid £18-19,000 annually throughout the two years of the course.

Don’t get me wrong, I think this is a well funded development of the healthcare professional workforce. I am just concerned that we have missed the opportunity to focus on those nurses in primary care (and elsewhere in the system) who would like to meet their patients’ needs by developing their existing skills.

Qualified nurses with many years of clinical experience can study part time at a university for two years, remain in the workforce as they do so, and with the support of a mentor in practice, become an advanced nurse practitioner. They can assess, diagnose, refer and prescribe (always of course within the limits of their competencies) and provide ongoing, patient-centred support for those in their communities who have long-term conditions.

So, the exam question is: how can the development of advanced nurse practitioners in primary care be supported at such a strategic level to meet the transformation agenda?

Crystal Oldman, chief executive, Queen’s Nursing Institute

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