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.

The media doesnt help us at all.

I have a bit of leave coming up, so maybe that'll help!

The ANP at our practice is wonderful! We see her a lot as my DD has a learning disability and regular illnesses and she is amazing. She remembers the names of all my children and asks after them, takes whatever time she needs with you. She arranged a special flu vaccine appointment for my DD when she refused to have it at school. She is so good. She argued with the hospital for me when DS needed a paeds referral and they refused. I’m sure your job is hard and exhausting and there are lots of difficult patients but I’m also sure there are many more who really value you.

Whereas I am glad my mum saw the paramedic rather than the GP who had fobbed her off the day before. The paramedic sent her to a&e and possibly saved her life as she had dvt.

I hardly ever use the doctors. But when I have and it's a straightforward issue I am happy with the ANP. For a while the kids had to have prescribed eye drops for hayfever in school (fortunately that has relaxed now). ANP could do it, and give the other prescriptions needed.

I'm also a big fan, ANPs generally are more up to date with their knowledge and have a much better bedside manner. I think in particularly older patients don't really understand the qualifications of an ANP which is also a role I had never come across in the village where I previously lived.

Saw 2 GP’s & an ANP when I had a chest infection which wouldn’t clear. Guess which one prescribed the correct course of treatment for me…
Clue: it was not the male GP’s who didn’t listen to me. One of which wore a mask under his nose 🤯

I'm sorry that you have been made to feel that way. I adore the advanced nurse practioner at our surgery. She takes me more seriously than the GPs do. When I was suffering from horrible recurring breast infections, I saw more than one GP about it but it was the nurse practioner who figured out what was causing it and since then I have never had another one.

A couple of years ago,I found a small pea size lump in my breast.Terrified ,I put off going to Doctors for 2 weeks until I was nagged by DH to go.Got appt with ANP the very same morning .Very professional ,I had a fatty lump thankfully .She drained it and prescribed Antibiotics I would be happy to see ANP any time

The issue for me is that a GP has had many years of training and it is a distinct regulated progression for a reason. I am sure GPs on this thread will acknowledge this.

I as a patient do have reservations about diagnoses being made by others than those with the widest possible training. This is not mean as disparagement but a simple acknowledgment that I would like my family.seen by a clinician with in depth broad training .

take skin cancer for instance; a cancer can be initially hard to differentiate from other dermatological conditions so if there was suspected cancer it would make sense for a GP to look at all such cases and avoid any cases falling through the cracks through misdaignoses.

With the increase in quasi clinician roles with variable scope for diagnosis and prescription are we heading for a system where you may get an under qualified opinion on the NHS and only a full qualified opinion privately?

It may be in a decade people will be saying to each other that you should be seeing private GPs if you can afford to ensure the broadest most expert treatment.

in my practice the GP is either remote or acts as a consultant for more complex referrals which is worrying as I haven't physically seen a GP in some time.

Have to disagree, a lot of GPs don’t like to diagnose/prescribe because it’s an area they aren’t familiar with it’s not can’t and I can absolutely assure you , the people who preferred to see me were involved in secondary care so could have seen the consultant as easily but requested to see me as they just felt more comfortable, the consultant I worked with was excellent I should say, not sure why you say this is exactly the kind of thing that makes people hesitant to see Anps, are you suggesting we don’t know what we are talking about

But for something like a UTI ,tonsillitis or a bit of eczema which would never have needed a hospital referral an ANP is ideal.

@mids2019 but an ANP also has years of training and one would assume that they were able to recognise when something was above their remit/refer on as a fellow professional.

There are plenty of MH conditions they cannot diagnose, and even for the ones they can prescribe for (anxiety, depression) this should best practice be accomponied by a referral. And yes, I'm suggesting you don't have the same training, experience and knowledge as a psychiatrist. No, I'm not saying that means there's no place for MH nurses as ANPs in the management of already diagnosed conditions.

Think many GPs are fed up. Because 1,500 new GPs qualified this year and can't get jobs. Because ARRS funding pays for anyone but a doctor.

I am sorry OP. I've had many really good ANPs, but when I already know what the problem is. Diagnosing should be done by a doctor as it's complex - you either need all the training and exams, or you don't.

@MrsBobtonTrent ...so are GPs not "proper doctors" ?
Gosh funny how during my five yrs at medical school, five further yrs of specialist training, and 20 further years working as a GP...I never realized I wasn't a proper doctor.
How bloody rude can you be ?

Why not replace all GPs with AnPs and PAs if they are more skilled, empathetic and cost less for the tax payer. Problem solved.

Unfortunately even though some clinicians can lack a little in the amount department (probably due to time pressure) can we please not underestimate the complexity of medicine as a subject of try and suggest the years of advanced training for GPs and consultants is without reason.

I think we are all entitled to the best possible care with the NH S and that includes a reecognition that access to GPs and then secondary care is paramount.

I am more than happy to see an ANP or paramedic etc for minor illness.
It works really well if the surgery does a good enough job of triaging patients to the correct clinician.
There's clear guidelines on what an ANP, Paramedic etc can do and what should be sent directly to a GP.

I am also an ANP, I work in a walk in centre seeing exactly the type of conditions you describe in your OP.
It’s a great environment to work in. We are entirely ACP lead (nurses, paramedics and physios) but no Drs. We are given approx 30 mins per pt (as some injuries can be more complex with XRs etc). We don’t have Drs which removes some of the expectations from pts to be seen by a Dr

My background is ED but I’m not sure I could cope with the pressures of primary care. Maybe consider moving to a walk in centre?

The Advanced Practitioner I saw in November was brilliant - she prescribed the right things to sort out my immediate problem, but also gave me some useful advice on moving forward a longer term problem that's in my medical records.

It sounds like you're not considering ANPs training/experience, and are focussing on Drs training, then using that for what appears to be, quite a one dimensional argument.

Your example about skin cancer is problematic. Being able to distinguish SCCs/BCCs/melanomas is tricky on the face of it for a lot of clincians - this isnt a specific ANP thing. I diagnosed an SCC a few months ago, referred on, the patient had surgery last week. We have a GP that had done a specialist derm qualification, and a lot of the patients with tricky derm issues go to her, which should tell you about the level of derm training/experience of everyone else on the team.

Mimneedswine

Exactly.

GPs are incredibly well trained both in breadth and depth. We have really high standards for entry into medical degrees for good reason. I don't think we should give governments of any stripe an easy pass by making savings for the NH S by artificially providing proxies for a standard of care we as tax payers should be entitled to.

by bringing in more and more proxies such as PAs into general practice we are setting up for a two tier health care system in this country.

Wow, you really have a thing about ANPs, obviously we don’t have the same training, doesn’t mean we are not highly trained, especially in areas like mental health, perhaps you should talk to the consultants we work with and ask if they think we can do our job, my role and that of my fellow ANPs in the trust, fully supported by the consultants, senior managers and Chief exec involved diagnosing and compiling treatment plans and follow up for people from new, not just those already involved with services, it’s attitudes like yours that make the role in all fields so difficult.

I’d much rather be seen by an ANP than by a PA

It can sometimes be hard for patients to work out who does what within a practice, which might lead to people expecting a doctor for anything/everything

@mids2019

I don't think that anyone is saying that nurse practitioners are more skilled than GPs. Just that they do a very important job and are more skilled than they get credit for.

Yes GPs have a great deal of knowledge, but you have to be taken seriously to benefit from it. There are many GPs who are compassionate and will listen but unfortunately, there are some that will not. Nurse practitioners tend to have a better bedside manner on the whole and have also gathered a large amount of skills and knowledge over the years. They are able to deal with a large amount of common ailments as well as being able to identify or suspect if something is more serious, if it is not within her ability to deal with, she can refer you to the GP and advocate for you if need be.

The first bit of this reply tells me what I suspected. You're missing the nuances of the role really, and you seem quite closed off to it.