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.

We have no ANP and the practice nurse only works two mornings a week.

The only thing I see the GP for is my blood pressure as we're currently tweeking my meds. Everything else, I ask for an appointment with a nurse practitioner and they are usually available in the next day or so. Sometimes I've even been seen in a few hours.

@Graphista - Wide words! You sound like our recently retired nurse who was pretty darned fabulous!

@ShiftHappens

I don't think you really understand the range of experience and training that an ANP has.

Not everything needs a GP appt. Our GPs are really struggling and when people absolutely insist on seeing one for things which a nurse can deal with it makes things very difficult.

@Graphista - I know that there are brilliant pharmacists out there. If I was still in London I would be perfectly happy to consult one. It is just that I am now in the middle of nowhere in Scotland now and I do not have as much confidence in the pharmacist here in the village.

I asked months ago to see a nurse for a diabetes test. I was told I needed to see a doctor to talk it through. But there weren't any doctor's appointments for non-emergencies, none at all in the 3 weeks she could access on the system. So I left it, as I'm a busy person and can't afford to waste half an hour at a time to be told there aren't any appointments available, but a blood test genuinely wasn't an emergency so I couldn't have one of those appointments. I did try about 5 times at weekly/fortnightly intervals before I gave up.

Fast forward 6 months, I turned 40 and was invited to a well woman check up with a HCA (I don't think she's an actual nurse, she only does these health checks for various ages). Part of that health check was a diabetes test (that I'd been asking for for months), which obviously came back positive (which I knew because my family is riddled with it and I was having all the classic symptoms), and I was referred to the practice nurse. I still haven't seen a GP about it, and I probably never will, as it's dealt with by the nurse. I feel significantly better now I'm on medication, most of my symptoms have completely disappeared.

So for me, I was perfectly happy to see the practice nurse, positively begged to see her, but was told no by the receptionist. It's not always the patient's fault.

We always get asked if our visit is treatable by a nurse/practitioner. Tbh it is very rare that it is but on occasion it has been I happily see the nurse.

The receptionist probably doesn't suggest the ANP as MN tend to have a real problem with telling them why they are asking for an appointment

Can I have an example of something that and ANP cannot do and would hawb8to refer to GP?

• have to

@Crunchymum

I think that ANPs can treat everything but probably need a GP to sign prescriptions which have sleeping pills/some opioid medications on them.

They can refer patients to consultants, just as GPs can.

"YABU. an ANP has not studied medicine." Wtf do you THINK they study?! Do you even know how much training and qualifications they have?

"ShiftHappens

I don't think you really understand the range of experience and training that an ANP has."
Totally agree!

Tistheseason17 - thank you. I'm LONG out of practice now but keep in touch with those I trained and worked with. A lot of the time I think people see Gp's unnecessarily because we seem (as a society) to be losing grasp of common sense!

Op I'm also on west coast of Scotland but clearly not same part as you. Shame you've not got decent pharmacists ours are fab.

Re what they can't do - prescribe certain controlled meds, particularly if it's the first time the patient is having that medication, make referrals to specialists in certain circumstances, they may refer you to the GP if they struggle to diagnose you (perhaps if you have a rarer condition, or one that one of the gps in your practice has specialised in), certain minor outpatient surgeries...

It will vary depending on their training and experience.

I'm a practice nurse. I don't diagnose and I don't prescribe. I will do your smear, your travel and childhood vaccinations, chronic disease management (not diagnosis and not acute illness), dressings, ear syringing, venepuncture, contraception, spirometry.
I'm not the person for your rash, your lumps and bumps or your shoulder pain.
Our ANP's are fabulous and dare I say, more knowledgeable and up to date than our GP's in some areas.

‘More knowledgeable in some areas’ is the important bit here.

Yes ANPs can be great but it is not true that they can see and do everything a GP can do. They do not in any way have the same breadth of experience as a GP

And I say this s somebody who has mentored many ANPs.

They do not in any way have the same breadth of experience as a GP

That really depends on the go and the anp!

A newly qualified GP won't have anywhere near the knowledge and experience of an anp that's been practicing 20 years!

My practice nurse wouldn't even change my sons very basic dressing. They tried to send us back to the hospital who had discharged him into their care

ANPs work in my local walk in centre (urgent care centre) and see patients, and they are fab. They don’t work for the local GP surgeries though (certainly not mine- unless a surgery was willing to pay the additional wage - and they’re pretty highly paid- they wouldn’t in others either )

My GP surgery has a treatment nurse come in for specific pre booked surgeries ie smears vaccinations. They’re not their every day with their own bookings

The practice can change their appt system to enforce this.

At our surgery all walk in appts are with a nurse. No choice of a dr. Pre booked appts are triaged by the receptionist and they strongly suggest if a nurse appt might be appropriate.

Aren’t most GP receptionists/call handlers trained to triage you to the most appropriate professional anyway? The only time I specifically ask to see my own GP is to discuss my mental health because it’s easier not to have to go back to the beginning of the story every time. Otherwise I usually see a practise nurse to discuss my asthma or contraception, and if I had an urgent concern, I would see literally whoever could see me on the day!

I see them all the time ! GP reception asks
For problems and assigns accordingly
In fact can’t remember when I last saw a GP
I like my surgery

Our practice use receptionists to ask questions and then they direct you to appropriate practitioner. Not always helpful as you are then referred to a GP and so time is wasted.

My surgery only ever seems to give out appointments to see a nurse, and the wait time is currently 5 weeks.

A newly qualified GP won't have anywhere near the knowledge and experience of an anp that's been practicing 20 years

Quite right Graphista and well said.

We’ve got both Nurse and Paramedic practitioners at our practice, and I think plans for a physio to be based there too.

I’d happily see either, most of my visits are quite minor anyway!

Advanced nurse practitioners are very qualified and experienced. They handle a lot of issues that you would normally see the GP for and they should be utilised more.

But they're not doctors. Their medical knowledge is good, but not as extensive and their ability to work without some supervision limited. They don't have their own regulatory body (GMC have controversially agreed to regulate them in future) and their malpractice insurance is a little iffy compared to GPs.

IMO, they shouldn't see repeat appts (i.e. ones where the issue has not been resolved), also a lot of hospital depts will not accept referrals from ANPs.

I've always asked for the prescribing nurse fo all minor infections for me and the kids, much better use of resources. If the nurse thought we needed a doc they would refer 99% of the time nurse was the correct person as either self help or abs for simple bacterial infections was required