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 was extremely grateful to the ANP at my surgery who saw me the same day i contacted the surgery diagnosed a chest infection and prescribed antibiotics to clear it up quickly. Without her I could have become extremely ill.

Thinking about it one was was a paramedic, I'm pretty sure I was told the other was an ANP, I saw her for a MH issue and it had taken a lot to call up and try and get an appt. She said she couldn't prescribe, referred me to MH nurse, several weeks delay, then nurse was unsympathetic and didn't really seem to understand my anxiety ( caused by DD serious illness) she said she also couldn't prescribe and that I needed to step back from worrying about my DD, in the end I was able to see GP who prescribed medication for anxiety which has really helped me.

I saw an ANP about a chest infection recently. She was very thorough and I was very happy.

I think you probably do a great job and the one time I’ve seen an ANP she was fine. However, I had called the GP surgery wanting to see a GP and was given an ANP appt with no discussion or prior info that this was the case.

This was done at time of booking by a receptionist - “you’ll be seeing X” with no explanation given that “X” was not in fact a doctor.

Felt duplicitous

I am a clinical nurse specialist so I empathise. I don't work in primary care. I hear what you are saying about ANPs and I really feel that you are being lumped together with PAs who have far less training and skills. It's a real shame as I think prior to this ANPs were highly valued in both primary care and the acute sector.

If you already know the problem then great...
ANP's go through extensive training in clinical assessment and differential diagnosis. Sitting exams/essays which are not easy, to show they know how to assess all systems, clinical reasoning for investigation etc. The prescribing qualification is a lot of work too with a high pass mark to ensure we know what we are doing.

Agree having a nursing degree and a good amount of experience before undertaking an ANP qualification is vital. We are helping take some strain from Dr's, who are pressured. Not trying to replace them.
Many years I've worked along side trainee GP's in the acute setting who I have helped with my experience in Emergency care.

The patients who moan tend to be those who stay in our heads (I’m a retired NHS mental health professional). I’m pretty sure that if you step back and think about it, more appreciate your help, than have a problem with it. Both husband and I think our practices ANP is brilliant and greatly appreciate her.

@Fifi27 I have said how valuable and amazing ANPs are. But I'd still like to see a doctor when I'm not sure what's wrong with me (unfortunately due to personal experience where I was mistreated for 6 months due to a wrong initial diagnosis, not by the doctor).

The ANP at my dads doctors surgery picked up a blood clot in his leg that almost killed him after his GP dismissed him twice telling him he had sciatica. You do a fantastic job and most of the time are alot better than GP's for taking time and understanding your patients. My dad is OK now but has issues following surgery etc and he sees the same ANP that told him he needed to go straight to A&E as she highly suspected he had a blood clot. He adores her. She is so lovely and she listens to him and she helps him. She is worth her weight and more in gold.

Please don't give up because you are valued by so many. I would perhaps look at finding a new surgery where you feel valued and appreciated

Just out of curiosity, what can you diagnose in mental health settings? Can you diagnose schizophrenia/bipolar/EUPD etc?

I suspect this is what is going on. I'm sorry OP because ANP is such a brilliant role and I have thought they've been great when I've been in contact

Think it's becoming an issue. Especially as some jobs now asking for an ANP or PA. Which is ridiculous as ANPs are much better trained with loads more experience. Hope nurses get angry about it.

I am very glad that ANPs like you exist OP! I have a recurring infection of the skin around my eye and, due to how many times I've had it, lots of medical advice and lots of research, I'm more knowledgeable than most of the GPs I see/speak to. I know what antibiotics I need and when. When I had the latest infection last month, the ANP was able to issue the prescription and I had the medication quickly enough to stop it becoming a really bad case.
On the other hand, my grandmother would have hated seeing an ANP as doctors were akin to God in her lifetime! many of my parents friends are the same.

My elderly relative's surgery has an ANP who visits the older patients in their homes. He is bloody fantastic with them, taking the time to listen to all their problems and encouraging them to share any other niggles they might have which often are important or connected but a GP typically doesn't have time to listen to. He follows up every single issue after the appointment and proactively arranges follow up visits to ensure resolution / progress. Real, old fashioned care.

I wasn't a fan of the concept of ANPs but my personal experience has changed my mind and now I am seriously grateful.

I’m sorry you’re feeling so despondent op. Please stay. We need you! I’d much rather see you and get a fairly quick appointment and know you’d refer up if it were needed. The equivalent at our local practice has been great.

Unfortunately I think part of the problems has been the lack of communication to people. It was a real shock the day I booked an appointment with what I thought was a doctor, and it wasn’t. I felt duped, overlooked and short changed. I might’ve been overreacting, but that was how I felt. No one asked my permission or communicated it to me beforehand. Even the second and third time I thought ‘what is going on?’ As it is, she’s been brilliant and I’m used to it now.

I think if the NHS had done a mass campaign to say ‘look, we’ve got no money and a shortage of GPs. If you book an appointment the likelihood is you’ll see one of our colleagues who has still had years of clinical training and can diagnose and prescribe for most common complaints. More serious issues will still be escalated to a qualified doctor.’ If people knew, and were reassured, they’d be less pissed off.

As I say op, don’t get down. We really do need you and as people get used to it, we’ll really value you and your time.

We do not have a shortage of GPs. We have unemployed GPs. There are enough to employ 3,000 more today, but they won't.

They are cheaper than PAs too.

If it was a mental health illness, I could diagnose it , so yes, the more routine stuff, depression, anxiety, OCD, also the more complex , bipolar, psychotic illnesses, personality disorders, my speciality was the so called affective disorders, so although it was within scope of practice, I wouldn’t normally be involved with psychotic disorders, other ANPs did the reverse, I honestly don’t know if that’s the same across all mental health trusts, but it was in the one I worked in

That's very interesting. I have a colleague who can diagnose and treat ADHD & autism, but that's it. I didn't know how wide a scope of practice MH ANPs had. It's great to see career progression and a widening scope of practice available for nurses.

Im sorry you feel like that OP. I 100% always book in with the ANP at my practice if I can because she is bloody LOVELY. Listens so much better than the GPs, actually considers my opinion and just has the nicest manner ever.

Do AHPs appear 'lovely' though because they have more time for empathy given that GPs are hideously overstretched? I see this quite a lot in my trust where consultant time is extremely valuable and they can be peremptory both with staff and patients. The brief efficient manner may be born out of necessity not through lack of empathy but the patient may be left with an impression of the medic being aloof or cold.

I saw an advanced nurse practitioner in A&E, she did the initial tests and took all the notes, questioned me with empathy and took everything down. This was passed to the Dr who read through and then saw me. They had only one Dr on duty though there should have been two apparently. I was still there quite a long time but it would have been far longer without her.

It reminded me a bit of when I used to look at applications for Masters students at the University I worked at as an administrator. I used to make a recommendation regarding admission having read through their applications. An academic then looked at the recommendation, it cut down time for them considerably.

@mumsneedwine do you have link at all to an article regarding GP not being able to get jobs, it’s not something I have heard of, many thanks.

In in Australia and locally we have a few walk in clinics that only have ANP. They are fantastic. We pay for GP visits here and the walkin clinics are free. We normally get seen within an hour including treatment. They hold.onsite A bunch of common medications so can not only write the script but also give you them which is fantastic ona Saturday night. They are also really clear about when you would need to see a doctor if you need one and if you turn up there but need hospital you don't have to re triage.
I wish we had more of them.

I hope you find somewhere you are more valued.

@CharSiu

www.rcgp.org.uk/news/member-research-jobsearch-struggle

www.bbc.co.uk/news/articles/crgg1wzpve2o.amp

dauk.org/glut-of-unemployed-and-underemployed-gps-ready-to-work/

There are many. Come August, there will many unemployed F2s too.

The fact that someone mentioned paying to see a GP maybe gives us a glimpse of the future? It seems to me we are slowly getting more and more of a triage system to see a GP with a GP being a last resort consultant whose time is managed essentially by those AHPs referring patients up to them.

Are we approaching new models of primary care with an extended WHO workforce essentially staffing surgeries with a relatively small number of GPs in place to act in complex cases or to refer to secondary care. Are GPs going to act like consultants in a hospital where often registrars refer up to them if a case is beyond their scope of practice but with PAd and advanced nurses replacing the registrar?

If this is the case I think the government should be more honest with the public and consult more widely in the model change instead of having change by stealth. Maybe it would be good to have a wide ranging discussion about the pros and cons of such an approach in a transparent fashion?

I think maybe if we did have this discussion then ANPs and PAs would have a former footing and their job roles would be more settled in public and medical perception?