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.

@mids2019 less trained staff are not often cheaper than a doctor. It's the stupidity of the leaders of the NHS and government policy that hires anyone other than a doctor. PAs earn 30% more than GPs.

Increasing medical school spaces is pointless if there are no extra jobs to employ them. Training posts are given equally to any doctor, anywhere in the world (we are the ONLY country who do not give preference to doctors already in the system), so doctors the NHS has paid to train end up having to go abroad if want a job.

Increasing staff (nurses and doctors are suffering the same issues) would be cheaper than recruiting less trained staff who end up costing more. But I won't hold my breath for common sense to prevail anytime soon.

What do other countries do?
Do they all revere their health services at god status?

@mumda nope. They want a job, paid at the rate doctors earn. Do you really think £43,000 is excessive ?

@mumda nope. Other countries pay their staff a decent wage, offer decent conditions and provide better healthcare because of it.

Me too.

Most of my GP visits are for stuff like "do my kids have an ear infection/do I have a chest infection that needs antibiotics", "does this rash need a cream" and ANPs are great for that. In my practice all the routine stuff is dealt with by ANPs and only more complex cases go to GPs. It's very effective and I usually get seen same day. It must be boring work for the ANPs a bit, though.

Skin rash to me could be a simple infection, squamous cell carcinoma or some kind of allergy. I want to see someone at least acquainted with all these conditions before getting recommended the cream imho.

This thread snacks of non GPS are brilliant until they arent...it's the the things that could be missed that worries me.

What's the pay around the world for doctors?

@mumda Australia about £85,000, similar for NZ. US over £150,000. Europe about £70,000. Hope that helps.

PS most younger doctors now also have £100,000 of student debt.

There's a lovely chart here. Ok it's for specialists...

https://www.euronews.com/next/2023/08/11/doctors-salaries-which-countries-pay-the-most-and-least-in-europe

GPs are specialists.

That chart is useless as shows maximum amount possible for a hospital consultant in the UK, which these days is unlikely for most doctors. Most earn nothing like that !

www.bma.org.uk/pay-and-contracts/pay/resident-doctors-pay-scales/pay-scales-for-resident-doctors-in-england

Hi. Im an ANP and am acquainted with all those things. Again, you're just showing your ignorance about ANPs.

SALARIED GPs. Most are not these days and are on local contracts (so much less)

www.bma.org.uk/pay-and-contracts/pay/gp-pay/salaried-gp-pay-ranges

@Imhereyetagain can I just ask what a GO can do that you can't ? Because if it's nothing I really think we need to stop doctors having to jump through so many (expensive) exams and rotations. I'm happy to think they don't need to do it !!!

No they dont want more there is no available funding to employ the gps out of work now locum oppotunities have dried up due to funding being used for additional roles.

They deal with patients with complex medical histories, or complex presentations. I wouldnt do that as I dont have the medical knowledge/training for it.

Oh and ANPs dont see pregnant women due to the complexity of it, and babies <1 (unless they've done specialist courses/training)

@Imhereyetagain but how do you know it's complex before seeing them ? I think ANPs are awesome at treating but diagnosing I'd like a doctor in case it looks simple but is not. You just don't know what you don't know.

But I think all nurses are amazing humans.

So you know if a patient has a complex medical history before seeing them - they dont get put on my list.

Complex issues that present as a simple issues are generally harder to treat and to spot, so the patient may come back a third/fourth time as the given treatment has failed. This is qutie rare tbh. GPs have this issue as well, so its not just ANPs missing diagnoses. Theres a saying 'common things are common', or 'when you hear hooves, dont think zebras' - everyone tends to treat/investigate the most common ailment its likely to be first, then if treatment fails or investigations come back as normal think about things more broadly. This isnt an ANP thing, this is a general medical thing.

We can spot red flags though - this is an important, if not THE most important aspect of our job. We know when to refer to secondary care or the GP, we know the limits of our knowledge.

I'm sorry you feel undervalued.
Tbh I've been referred to the nurse few times at my surgery and they then can't prescribe and need to ask to doctor to do me a prescription, later that same day, which delays my medication and means I have multiple journeys or they say I need a GP appt which they cant give me so 8am the next day I'm on repeat diall/hold for 40 min desperately hoping I can get through and get an appt before they run out, frequently I need to try on several days before I get an appt.
So at the end of the day I just want to see a GP because then I know they can deal with my problem/prescribe/refer etc and it doesn't waste my time or delay treatment.
It's not personal, maybe you are more qualified /able to do more than the nurses I see or maybe receptionist just try and get you any appt or it's a delaying tactic who knows but I am sorry you feel that way. I think it's a good idea in principle but for the right kind of health issues and not used as a/ barrier/ hoop you need to jump through before you are allowed a GP appt.

You can also know its complex before seeing them by looking at what the patient is telling you.

• "Years of abdo pain and its not been solved"

• "my left foot is suddenly numb"

• delerium/confusion

• suicidal

These are just a few examples of the more complex stuff that would go straight to the GP.

If they cant prescribe, im going to go ahead and guess that they're not qualified ANPs. ALL ANPs can prescribe - its part of the masters training.

I love the nurses at my doctor's- they're often more helpful than the GPs!

@Imhereyetagain sounds like you do an amazing job and should be v valued. Thank you for doing it - lots couldn't.