People don't use Practice Nurses/ANPs enough

[TheMustressMhor]

I am always reading threads from people who cannot get GP appointments and I wonder why they don't book to see the Practice Nurse or Advanced Nurse Practitioner instead.

I know that these HCPs also have a long waiting list in many surgeries but they can and do diagnose and prescribe. They can also refer you on to the GP if necessary.

AIBU to think that most people do not understand the rold of the Practice Nurse/Advanced Nurse Practitioner and that their services are not used as much as they could be?

In my own practice there is a very competent ANP, one full-time GP and two part-time GPs.

There is also a Nurse available for dressings/smoking cessation clinics etc.

The ANP is the person I go to first with most problems.

I assure you that I'm not offended Tistheseason.

Well that copy and paste did not work!!

@TheMustressMhor - Awesome!

No ANP at my surgery and the practise nurse and I do not get along after she gave me some very dangerous incorrect information about my sons asthma...
But if there was an anp I’d happily go, we’ve seen them at the hospital a few times and been very good

I always try and see the ANP myself and my husband both have lifelong medical conditions and he knows both our cases well, if we ask to see a GP theres a choice of 6 and then we have to go through our conditions. But I would still refer to the ANP as the gp eg if I say I'm going to the doctor I mean either the gp or the anp.

I entirely accept that there is good and bad in all professions Tistheseason.

I am sure there are excellent pharmacists out there. I have met some in London but not in Argyll, unfortunately.

We've got a wonderful ANP and ANP in training at my surgery. Went in for a smear, ended up with strong meds and a hospital referral. She's just issued a repeat prescription to get me through to my op. All this for the same issue I'd seen the GP for, who had insisted on several occasions I should just take over the counter painkillers.

Maybe it depends on the GP practice. Pretty much everytine I’ve made an appointment for DS the receptionist has a arranged an appointment with a nurse - no problem for me at all. On occasions where the ailment was serious or she wasn’t sure she then asked a doctor to come in for a second opinion.

Most GP practices have an in house pharmacist now, and many are prescribers. Really valuable service and many are running clinics -asthma, diabetes, hypertension etc.

i've never heard of an ANP, no idea what it stood for. our practice won't even take blood, needs a 15 min walk and wait for two buses to hosp, and only one hosp doesn't require pre-booked appts for blood tests, hence often 2 hr waits after checking in.
I find it really annoying that the form for blood tests includes hosps that are 2-3 hrs away by public transport. takes a whole afternoon with travelling. cannot park either as on street is imposs and limited hosp car park is £3 per hour, so at least £6 for a blood test. since they built on one car park the queues are often one hour just to enter.
the attitude seems to be, look you've got a wide choice, 5 venues. why can't they co-operate so that another nearby GPs could take our blood. people who need test are often ill, elderly, disabled, or rushing around looking after children and getting to work.
I've got various symptoms that could/should be looked into, but I've more or less given up trying to get appt at GPs. find it so dispiriting.
grateful to have had the flu jab though. any one think I should try for pneumococcal, not been offered it, but willing to pay.

I've never not had appropriate medical advice at my practice. If it's one of the nurses/ ANPs that's fine as long as they can deal with it. A couple of times, an issue has been dealt with over a phone call even (persistant diahorea continuing long past recommended time scales, and a child with suspected thrush/ water infection, both needed a sample sending off after, one a prescription that was then sent directly to the pharmacy).

I want appropriately timed medical advice with someone who can deal with it. I don't want to insist on a GP and have a lengthy delay.

@alexdgr8
There is weird funding issues causing loads of problems.
Hospitals are given money to do blood tests for patients they see. GPs are only paid for blood tests they initiate and some for warfarin.

In essence GPs would love to be funded to do your blood tests but whilst the local clinical commissioning groups (CCG) do not pay the GP practices for this work, they cannot simply afford to employ people to provide unfunded services - already had too many funding cuts

it would seem so simply to transfer this funding from the hospital to the GP practices but our local CCG has been asked to do this for 5+ years and has not succeeded.

Best place for the patient is local - but appropriately funded and risk assessed.

The other thing to note is the clinician who takes the blood receives the results and is responsible for them - very dangerous if they are test results where a consultant input is required - GPs are not hospital lackeys - although some think they are..

my gp has a sit and wait system to see a nurse practitioner (they have 3) if you call up on the day and you need to see someone urgently, i find them more approachable than most of the gp's at the practice.

do you find that patients refuse to make appts. with your ANPs?

Sometimes they do. Or question why im offering a nurse. Or sometimes they are rude, asking what can a nurse do?

Last practice I was at it was the ANP who diagnosed all the issues I had. The GPs were piss poor, they had a very high turnover of receptionists and difficulty keeping GPs they trained. Got to the point where I didn't want to see anyone but the ANP.

My current practice doesn't have any ANPs but they have a low turnover of receptionists - who aren't rude - and manage to keep a lot of the GPs they have as trainees.

Oh and the pharmacists I've asked for advice have just referred me to my GP, so now I don't bother asking them anything.

My practice does have an ANP but she doesn’t run a clinic in the surgery. She covers a number of surgeries in her ‘catchment’ and does home-visits to try lighten to the GP load on that side.

I know this is a very niche problem but I tend not to go to our local pharmacist because he was at school with DS and he gets embarrassed! (I don’t!)

I've never been offered an appointment with the nurse or been told I could have one, but on the rare occasion I've been to the doctors lately I'll say I don't mind seeing one if appointments are available.

Yanbu - I am an ex nurse and I often say on "medical" threads where appropriate that other hcps can deal with X y z.

I have friends that are pharmacists, practice nurses/anp's, chiropodists, optometrists, physios etc and I think we could really do with a great public health campaign explaining to "lay people" just how much these other community hcps can do.

People are often surprised, even shocked when told just how well qualified and trained other community hcps are.

If you're not sure what your practice nurse/anp can do - ask!

My GP surgery (admittedly I suspect in an effort to reduce unnecessary GP appointments) has a message when you first call BEFORE you do the menu and get through to the receptionist (if you choose that menu option) that explains that the receptionists have been trained to ask patients roughly why they need an appointment in order to direct patients to the correct service. Within the same building (it's more like a community centre really, also contains social workers, carer support and debt & welfare advisors) there are in addition to the gps and practice nurses:

a treatment room staffed by nurses and hca's who are perfectly capable at cleaning and dressing minor wounds, removing stitches, dealing with small splints and things like checking if support aids for arthritic wrists are being used correctly. They also do vaccinations, inc overseas travel ones and blood draws (I'm murder to get blood from - crappy veins - and there's one hca who used to work in scbu who "gets me" every time no problem! Love her!)

Physio dept

Chiropodist

Pharmacy - a fantastic very experienced and approachable chap who's helped us a great deal.

Primary care cpns

All of which patients can "self refer" to - meaning you just make an appointment with them directly.

I think the same is true for community midwives but I'm way past that stage now.

I have though, on occasion had to explain to (mainly new) receptionists that for certain things that would normally be dealt with by other hcps, we (dd and I) due to our chronic conditions complicating matters, we do actually need to have GP appointments and that the gps are aware of this and this is what's been agreed between them and our specialists. But generally the receptionists know us and understand those differences.

But yes, where possible we use alternative hcps.

@lululup - it depends on the nurses exact qualifications and the drugs concerned. It sounds like unfortunately in your case that nurse suffers from a combination of lack of qualifications for the role they're being expected to cover and a lack of confidence.

"What kinds of things can the nurse see me for?"

I'm sure I'll forget some things so apologies there but most can see you for:

Minor ailments - the usual bugs and niggles. Coughs, colds (though really unless you have complicating conditions a pharmacist would be best bet if you're struggling to treat yourself), flu, chest infections, sore throats, sinus issues, headaches, stomach upsets, minor period issues, cuts and grazes (if beyond the scope of home treatment),sprains and strains, monitoring of certain chronic conditions, earache, family planning and sexual health, uti's, weight loss/healthy eating advice, certain health screening, smoking cessation, immunisations, blood draws, prescribing many of the "common" prescriptions (dependent on their qualifications), ecgs...

As I say I've probably forgotten some!

Really you only need to see a GP for serious symptoms or if you have conditions which can make "minor" ailments become a complicating factor of that condition. Eg I have awkward difficult to control asthma which flares badly whenever I get a chest infection so its actually pointless me seeing the nurse as they will tell me to see GP anyway, even the GP's can lack confidence dealing with it sometimes and make me go a&e. I've also a shit ton of allergies inc many antibiotics and the few I can have are generally not ones commonly prescribed and so I've found many nurses prefer to defer to GP on the issue.

But I also have a disability & pots which can make me more prone to trips and falls and injuring myself if I've fainted awkwardly so I've frequently seen nurses to have them deal with the resulting injuries. I've also found them far more sympathetic when I've had issues with my endo, less judgmental on sexual health side of things, better at taking my stupidly low bp, better at accepting that if I'm on a medication that's working for me I DON'T want to change it just because the hcp is unfamiliar with it!

"YANBU, and I also think sometimes people go to the GP with issues that could be looked at by a pharmacist" DEFINITELY.

I have 2 friends that are pharmacists, one "high street" and one hospital based. They are extremely well trained and highly qualified and FAR more expert on not only prescription medications but otc meds and tried and tested home remedies than the vast majority of gp's.

They and my GP pharmacist have kept me right (the GP pharmacist even saved my life! By spotting that a medication I'd been prescribed was one I was allergic to but the name had been changed so I didn't realise!) on meds and doses, the kind of things I've found GP's are quite poor on picking up on/telling patients are things like if a medication will make pill ineffective, or certain foods/drinks shouldn't be taken while using as they reduce efficacy (cola affects a LOT) - I'm not talking the major ones that are often included in patient info leaflets but "minor" issues that just make certain meds slightly less effective. Also if they contraindicate with another medication or treatment I'm using. They're always happy to answer questions and can often come up with ideas of things that could work that a GP wouldn't necessarily. I also have poor memory and concentration, I'm resisting the dosette idea (stubborn cuss!) but on occasion I've not been sure if I've taken a med or not and I've called my pharmacist to ask about taking it at a possible risk of double dosing vs missing a dose and they've advised accordingly, also very helpful with side effects. I have a VERY sensitive stomach and found even meds that generally for most people are fine to take on an empty stomach have caused me issues. He's advised me well on this and now kindly puts a note on any new (to me) med if this is likely to be an issue for me so I know to eat first or take with milk or whatever.

"I really wouldn't want to see a pharmacist instead of a nurse or doctor." Why not? Ah you've had bad experiences op that's a shame. But not all pharmacists are like that.

TaliZorahWasNormandy - but does your practice try to inform patients?

"Who really needs to see a GP for a cough (unless they have had it for 3 weeks as per NHS guidance)? And purleeeeeease - the amount of people who want an apppointment for a sore throat that started "this morning". neither a nurse nor GP should be seeing that." Totally agree! And on other Nhs/medical threads I've stated/agreed with others saying so that we seem to (as a population/society) have forgotten that many ailments can easily be treated with simple common sense/home remedies.

I was raised by parents who came from very poor backgrounds and my grandparents had therefore obviously reached adulthood not having the money to use a dr or even other hcp unless absolutely necessary as no Nhs then. As a result those generations of the poor/working class were well used to doing their own/Children's 1st aid or treatment of minor ailments, and knew which ones worked too. So I'm well used to things like honey, lemon & Ginger for sore throats, colds etc, baking soda for indigestion (great for trapped wind!), milk for heartburn, banana toast for diarrhoea, licorice and prunes for constipation, arnica for bruises, aloe for cuts and grazes, eucalyptus oil for blocked noses/colds/blocked sinuses, ginger biscuits for nausea (practically lived on these in early pregnancy! Taken with peppermint tea), temple & nape of neck massage for headache, Epsom salts for aching muscles, lavendar bath for sunburn...

Far too many now seem to expect an instant cure from a strong drug. Medications have their place but they are powerful substances that can harm as well as heal and should be treated with caution and respect in my opinion.

Just looked at my GP website. Large practice on two sites -
15 GPs, 4 ANP, 6 practice nurses one is a cpn and 4health care assistants

Website explains extra work provided by
-GP
GPs (minor surgery),
-practice nurses doing clinics, vaccinations and immunisation

• hca wound dressings and various other home visits
• triage and minor injury nurses ?? Are these APN or someone else
• A 365 day nurse triage service (separately to one above) that may be accessed for same day needs

-cpn -midwife

• substance misuse clinics

I’m confused. I’m quite new to the practice and so far just know getting GP appointments is very hard. I have an outstanding hospital referral and rang to ask if they could chase this as my condition has got worse, I was offered a phone appointment (no otger option) which I would’ve been happy with except that it was for Monday, not even a vague idea what time on Monday like morning or afternoon, Unfortunately can’t have my personal phone on all the time at work, might have been able AM or PM but didn’t want to waste a GP appointment.

I'd never have a smear with a doctor if I could go to the practice nurse. They've always got more time and patience.

My friend's DH who's a pharmacist knew far more about my husband's options for blood pressure drugs when he was having adverse reactions than the GP and he's now on a much better prescription for his age and circumstances.

I see an osteopath rather than a GP for my back as they have far more specialist knowledge and better treatment options.

I also treat myself for issues such as minor fissures or piles. I literally only go and see a GP if I don't know what's wrong but I have worrying symptoms or it can only be dealt with by the GP.

I do think there are some people that would see a consultant if they could for every minor thing, just in case. But my view is we have to protect our NHS by using it as sparingly as we possibly can and seeing the least qualified person who can deal with our problem.

Think people are unaware the amount nurses can do now. At our surgery we have nurse prescribers, one is trained to fit coils and remove them. Nurses are becoming very advanced in primary care work.

YABU. an ANP has not studied medicine. They don't have nowhere near the same training and qualifications as a GP.

Just because you had a good experience, yabu in harping about that others should see the nurse when they need in fact a GP.