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.

If ANPs can do pretty much everything a GP can, why are we going to so much time, effort and expense training so many of the most intelligent and competent people in the country to become doctors?

@Endofthedays I think at least partly because wider society still thinks "just a nurse" isn't quite "good enough"

But I'd love to hear from GP's and anp's if there is really a significant enough number of patients that really need to see a GP to warrant focusing on more GP's RATHER than more anp's - of course more of both would be great.

I rather suspect the vast majority of GP/primary care appointments could be perfectly well dealt with by anp's.

In an ideal world primary care would be sufficiently funded and resourced that they could focus more on preventive rather than reactive medicine

Certainly I'd prefer as a patient not to get ill in the first place if possible! Not always possible of course.

And while I am a huge supporter of the Nhs I do agree it needs to be used appropriately.

There are issues (and these still even happen in places where healthcare is privatised) with people going to see an hcp with things that they are perfectly capable of dealing with themselves.

Most coughs, colds, sore throats and similar are self limiting and easily treated (the symptoms) with home remedies and self care.

I've just remembered the time dds friends mum looked at me like a wizard for knowing how to get w splinter out of her daughters thumb with the mere basic tools of sterilised needle and tweezers!

If I'd said to my mum I'd sent a child to the Drs for a simple splinter she'd have found that hilariously unnecessary.

Just a nurse isn’t good enough.

But presumably ANP’s have gone through training and exams similar to the ten years it takes to become a GP and are not ‘just a nurse.’

Most people presumably don’t see ANPs or GPs for minor ailments; they see them for long term chronic health problems - mental health problems making up a large number of them.

The last two GP appointments I've had were for de novo food allergy symptoms and to discuss what I wanted included in a medical evidece letter for a course I was on.

I suppose an ANP could technically have dealt with both, had there been one, but it is more efficient for me to speak to the GP, who will actually be writing the letter, rather than risking Chinese whispers.

I do have complicating, chronic issues, and it's generally very difficult for me if I see someone who doesn't have some understanding of these.

I had an ANP handle

Kidney infection diagnosis and prescription
Warts
Repeat prescriptions
UTI

Not discrediting GP at all . But I think for my dad to day issues an ANP suffices . They are after all a gateway between the surgery and a referral anyway surely

So yes . Maybe the model needs revisiting

I also think pharmacists need more power to prescribe (anti biotics maybe not !) for
Some Medications . I shouldn’t need to waste anyone’s time to get extra strong thrush cream , or my back pain pills 💊

A GP is not needed for day to day ailments . Where they are critical is early diagnosis and pushing people through the system and diagnosis

One in four practice nurses is due to retire in the next ten years (myself included), so that wait for your smear isn't going to get any better. Pharmacists have their place in all this, but I agree, IMO are too quick to say see your GP.

Where I am, ANPs are at least a band 7 with senior autonomous professionals working at an 8a. They have years of experience, additional specialist training, a huge range of skills and a wide scope of practice. They can assess, diagnose, treat, order tests and interpret results, refer and prescribe for a wide range of conditions within their area of speciality. It’s a shame there aren’t more of them.

There are a few more nurse practitioners knocking about (the level below) but even then, they’re scarce.

There is a real worry re practice nurses retiring in the next few years, @cptartapp says. In my area the sexual health clinics used to be able to do smears too but they lost the contracts a couple of years ago and now they are all done in primary care, adding to the burden.

I love the nurse practitioners at our surgery who seem to be GPs in all but name. And one of our local pharmacists is an independent prescriber. But can anyone link to a decent explanation of what on earth the limits are for what ANPs/PIPs can and can’t do? All I can find online is ‘anything within their competence’ which is no help at all!

Well in my experience the ANP just didn’t have the knowledge about specific risks/benefits of medication but the GP did and could prescribe stuff that wasn’t strictly licenced for my condition. Maybe that’s the difference.
I reckon there wouldn’t be much difference between and independent prescribing pharmacist and GP for a lot of cases, pharmacists have so much specialist training about medication already.

I have had procedures done by ANPs at hospital clinics - specifically dermatology.

They are very highly-trained. Not "just a nurse" as a PP said.

I would love my pharmacist to be an independent prescriber. It takes over a week to get a repeat prescription, because the system is set up so I have to ask the GP (who didn't prescribe it in the first place, the nurse did) who takes a couple of days to get to my order (I understand this, they're busy people), then it sits at the surgery for a couple of days until the next time someone from the pharmacy collects it, then I can collect it from the pharmacy later that day. It would be so much more efficient if the pharmacist could prescribe it directly, as it's the same every month, and the GP/nurse could just inform them of any changes when I have my check ups (around every 6 months). That feels like a much more efficient way of doing things, but I imagine there are reasons why they don't do that (I can't think what they are right now, but there must be reasons)

@Chouetted

I suppose an ANP could technically have dealt with both, had there been one, but it is more efficient for me to speak to the GP, who will actually be writing the letter, rather than risking Chinese whispers

ANPs write their own referral letters. I think you're confusing ANPs with Practice Nurses. .

@themustressmhor But it wasn't a referral letter I wanted, unless a referral letter includes medical evidence letters.

I've seen one for DH in an out of hours service. He was wondering if he had a chest infection during what appeared to be a heavy cold because he felt so unwell. She said he had flu and said go on with paracetamol etc but that night he became really unwell and as I had the babies, I couldn't take him to hospital and we ended up calling an ambulance because it seemed our only option. He had pneumonia. Doctor told us after that he would have prescribed antibiotics in the out of hours and sent him home but he doesn't think it would have worked in time for him not to get as unwell as he ended up being as he would have taken one dose. I was angry at the ANP. Perhaps unfairly so. DH said she was sort of "man-flu" dismissive.

YABU

As bad as the online messages on the call waiting of my doctor's surgery telling us we can book online - despite there never being any appointments available other than a HCA for blood pressure tests, the diabetes clinic and the smear test clinic.

The idea that I'd ring 15 times just to even make it into the queue and then spend a further 15 minutes on hold just to speak to a receptionist if I could book online is ludicrous. What's worse, is that the doctor has requested the appointment and is holding my repeat medication to ransom, yet I have to take a day off work to try and arrange that appointment (not have the appointment just arrange it)

The vast majority of people won't use ANP's because they're not available to them

Our surgery doesn't have one, a huge part of our county doesn't even have a gp.

Yes people can only see an ANP if there's one available to them, we do not all live in cities with well staffed practices so not a lot of point telling folks to use someone who is not there.

Yes people can only see an ANP if there's one available to them, we do not all live in cities with well staffed practices so not a lot of point telling folks to use someone who is not there.

I live in a tiny village on the West Coast of Scotland and we have three GPs and an ANP.

The GPs are all part-time, though.

If we want an appointment with any of the HCPs we get one on the day we ring. There is also no queue to speak to the receptionist.

We moved here from London, where we belonged to a very busy surgery which had six GPs and no ANP.

Trying to get through to the receptionist often took days.

I do understand that many people do not have access to an ANP. But to suggest that they are only available in cities is incorrect.

Our village is vastly over-staffed in terms of HCPs. Nobody here who has lived in the village since birth agrees with me, needless to say. They do not understand what it would be like if we were in Glasgow/Edinburgh/London, for example.

We have a massive waiting room and there are never more than two patients waiting at one time.

I do not understand the NHS sometimes.

Weeks to get an appointment with a Nurse or GP around here. Lucky you to have the 'ask and ye shall be seen" option OP

I know @DeeDeeCherry. I do appreciate that.

I think the ludicrous quantity of HCPs here in the village mitigates the fact that there are no supermarkets which deliver (and no supermarkets for sixty miles, actually.)

We lived in London for most of our lives so we do understand how difficult it is to get through to the surgery and make an appointment in urban areas.

I used to wait for up to two hours for actual appointments down in London as well. That was normal.

Here - you go when your appointment is due and you're seen at that time. No waiting at all.