Im an Advanced Nurse Practitioner and whats the point

[Imhereyetagain]

Im an ANP in a GP surgery and I dont think the role is valued or appreciated. On the one hand patients moan that im not a Dr, and on the other Drs moan about the ANP job role existing. Im just so tired and bored of it all, and think about leaving.

My daily work is running an ANP emergency list, which really consists of any single, acute, undifferentiated problem. So things like chest infections, urine infections, simple dermataology issues, acute abdomens etc etc. I could go on but I think that illustrates my daily work fairly well. The more complex stuff goes to the duty GP.

Im just...tired.

I think the ANP role in Gp surgery is difficult, you can’t know about everything and some people, sadly including some doctors, think only doctors can diagnose, I was an ANP in mental health, I’d see people from new, diagnose, commence meds, review etc, quite a number of the people I saw clearly said they preferred to see me than the consultant, I never had an issue with the Drs I worked alongside but did on more than one occasion have GPs who refused to act on the advice I gave and insisted on their patients seeing the consultant, they were the times I really felt like , what’s the point, but the consultant invariably agreed with my plan and the only person that suffered was the poor patient who could have started treatment weeks before, stick with it or maybe look at moving to secondary care where you’ll be more appreciated

The ANPs at our surgery have always been great. I'm happy seeing them.

The patient perception is slowly changing I suppose, since patients have gotten used to the role. Years ago id have a few refusals a month, now its a few per year. Its taken a knock again as PA's have come into the mainstream media as I think people think its the same thing (its not). I had a patient on the phone the other day check I wasnt "one of those awful unqualified PAs".

GP is a mess. There are trainee GPs out there talking about deliberately failing their specialist training just so they can stay in their training roles, so they have a job.

I do believe there is a role for GP ANPs, but we need to stay in our lane. I hear of some running routine clinics and am appalled at that. I get why GPs moan about us. We were employed originally because there just werent any GPs. Now that problem doesnt exist anymore, but there isnt any money.

Maybe it's just the surgery you work at rather then the role everyone loves them at my surgery

Even most doctors (including GPs) can't diagnose and prescribe for MH conditions though, this is exactly the kind of thing that makes people hesitant of ANPs. I suspect people preferred because it was less 'hoops' to jump through.

I think it's perfectly sensible for the ANP role to exist.

If I have a basic minor medical complaint that doesn't require a great deal of experience to diagnose and treat and doesn't have any chance of being part of a symptom pattern for something more serious then it should be obvious and easy for me to see an ANP not a GP. Every day that you work represents a day shorter that a host of people who really need a GP have to wait for an appointment. That's a brilliant contribution. Thank you.

The moaners will be the worried well who feel they need a regular GP slot to reassure themselves that they are being looked after by someone. As a nurse you may have reached a level of compassion fatigue for such an attitude but their disgruntlement doesn't hurt you.

I love seeing an ANP over a GP. Longer appointment and I find that I'm listened to more and am more likely to be referred onwards in a timely manner. I've only ever received brilliant care from every ANP I've ever dealt with!

Also coming on to say that every ANP i have had dealings with has been great and very much valued. Maybe time to change practice, rather than role?

I also think the introduction of PAs has generally got up most people's noses so wonder if you are getting some of the backlash from that?

My friend went in to Aesthetics instead and is now self employed, earning an absolute fortune without any stress of the GP Surgery.

To those who seem concerned that the simple stuff hides the more serious - I can recognise worrisome patterns, have ref'd people for more complex investigations based on their history, ive spotted cancers that havent been diagnosed and referred on for investigation. So yes, the 'simple' stuff gets given to ANPs, but dont think for a second that we're happily wacking out the antibiotics and are ignorant to more serious things.

I just want to a) get hold of my surgery and b) see someone appropriately skilled for the condition involved.

The nurses we've seen for things like DS's asthma reviews have definitely ticked b) for me.

a) is a problem as the two minute window to phone up and get an appointment is right on "get out of the house" o'clock, and school would take a dim view of regular lateness to play a daily game of can we get an appointment.

I love our SNP’s - easier to get appts with then doctors and they are always so lovely!

The ANP I see at my surgery is amazing! She listens, she's empathetic and tries to get to the bottom of my many menopausal symptoms.

She is better than any of the doctors I see.

I know it's not much but I'd rather see an ANP at our surgery. They are all very experienced, listen and often give us tips to deal with a condition or illness that the GP wouldn't.

I'm sorry you're feeling so burned out

Would you consider a move to the acute sector? There’s been quite a few nurses in my work (ICU) who have moved on to be community ANPs and sadly their experiences seem to be similar to yours, irritated patient’s and unsupportive GPs, most of them have moved on to other things. On the other hand the ANPs I meet in the hospital are very respected and seem a lot happier. Certainly the ACCPs (advanced critical care practitioners) in my work are incredible and essential members of the team and our consultants love them in fact if anything there is occasional irritation from the junior doctors as the ACCPs are generally more trusted than them. I don’t think you would experience the same attitude from patients as they do tend to be seen by medics as well as ANPs.

As a patient I feel that the issue with ANPs is that you seem like just another level of fobbing off or another hoop to jump through before a patient to gets to see an actual doctor. Maybe that’s not the case, but it certainly feels that way. The effort to get through to a receptionist. The wait for a call back to see whether you are allowed an appointment. Having to have an appointment with some lesser minion who then says yes that needs a GP. A GP who then says yes you need a proper doctor. The wait for a hospital appointment etc etc etc. It’s gatekeeping. Like they hope the issue will resolve itself. Maybe sometimes it does, but I it doesn’t give me confidence in the NHS.

It can't come as any surprise to you. It's a money issue. A clever cost cutting plan by the nhs. ANP and ACP is a catch all term, it saves money, a new clinical role introduced, unregulated and ill-defined, leading to inconsistencies, cleverly to save money. They aren't doctors. The route in and training of a doctor should be respected and asking these people who are unqualified to step up and take on mire tasks and more responsibility is just a conn to the public.

I've had an ACP claiming to be a doctor in MSK when I broke my back. One of the GP's at my survey was livid, "I am a doctor she said, trained for years, and I'm telling you he is not".

<a class="break-all" href="https://www.google.com/url?q=amp.theguardian.com/society/2019/mar/21/colleagues-dismiss-me-role-eases-nhs-understaffing-advanced-clinical-practitioner&sa=U&sqi=2&ved=2ahUKEwjIgunplN6KAxUzTUEAHU2pMtUQFnoECBIQAQ&usg=AOvVaw1qQWTP1ZT9qH3SJwzGNOjS" rel="nofollow" target="_blank">ACP

Our ANP is absolutely super, clearly very experienced and a great listener. Always happy to see her.

I’m an ACP/ ANP in an acute hospital. Two of my colleagues left to work in GP surgeries, both of them love it and are well respected by their peers. Have you thought about changing practice? I absolutely love my job and, although there may be some negative opinions from junior doctors about ANPs, I have never encountered this is my practice. We get nothing but respect, the consultants all want to work with us, we support the junior doctors rotating through our service and I’ve never in my entire 10 years had a patient or relative who wanted to be cared for by a doctor rather than myself. I think you should consider another ANP role.

The NHS is under such pressure, it is easy to fall into a negative frame of mind and then we tend to only spot the negative stuff (cognitive biasing and all that) and completely miss any positive feedback. I’ve been through this myself. Could this be happening a little OP? It’s perfectly understandable.

The ANP at my surgery is an absolute legend. Fantastic woman. Valued by everyone, staff and patients. What sort of practice do you work for OP? I’m shocked to hear that GP’s don’t embrace your role.

I went in with a simple headache once which I’d had on and off for two weeks. It was high blood pressure, 235/130, straight to A&E, did I feel cheated that I’d been seen by an ANP? Definitely not.

Most people aren’t interested in the carping in the press on this issue.

I'm on medication that weakens my immune system so have had quite a few infections. I'm more than happy to see the ANP at my GPs. She's been there for years and I'm very happy with the care and advice I've received. She's also happy to call the doctor in when she's had concerns or is not sure about something. I think she does a great job 👍

Im sorry someone pretended to be a Dr - im sure thats illegal?

You seem confused between to the two roles, which is understandable to be fair. We are not Drs. I make it very clear in my consults that I am NOT a Dr.

I'm sorry you are not appreciated. My GP Practice has ANPs too. We have gynae and respiratory specialist nurses which are the ones i have used. They do a wonderful job and I prefer to see them as they have more training and knowledge in their areas than the GP.

Our practice has worked hard to make sure that patients understand all the different roles of the various HCPs though, which has probably made a difference in perception. There will always be those who don't understand and insist on a GP though, who will then send them to the ANP. 🙄

I’d rather see you than the paramedic I saw recently. He just went and asked the GP anyway, so no money saving there.

Please don't think you aren't appreciated! I recently saw one of you at my last appointment, it was an excellent experience (and I did tell her so). She was very thorough and I felt that she was actually listening to me and not, like some drs, thinking about something else. Then she followed up with a phone call a week later.

I totally get you are tired, but please don't think you're not appreciated!