Workforce/HR/Employment law

Employing an advanced nurse practitioner

A skilled advanced nurse practitioner (ANP) can do a large proportion of a GP’s work at a fraction of the cost, and bring numerous benefits.

What is an advanced nurse practitioner?

An ANP is a registered nurse prescriber educated at master’s level to be an advanced generalist. There is a wealth of evidence to support their effectiveness in primary care.1, 2, 3

Role

In a nurturing practice that allows room for professional development and is willing to support training, an ANP can develop in a multitude of directions. They can handle far more than minor illness cases.

Clinical

On the clinical front, ANPs can act as first-contact practitioners, seeing undifferentiated patients in the practice or on home visits. They can follow up these patients too, including:

  • Managing investigation results, prescription requests and documents.
  • Arranging referrals and admissions.
  • Performing more complex tasks, such as proactive care plans and care home ward rounds.

Special interests can be developed, such as musculoskeletal medicine and contraception: an ANP is a cost-effective practitioner for joint injection and implant insertion, for example. The RCGP has a detailed competencies framework for advanced nursing staff, which is useful in outlining and ANP’s role and responsibilities.

Non-clinical

Outside of the consulting room, ANPs are a vital member of the multidisciplinary team. As home visitors familiar with the practice’s must vulnerable patients, ANPs are well placed to chair MDT meetings for case planning or palliative care. This can free up GPs for other tasks. ANPs are also well placed to appraise practice nurses and healthcare assistants. They can lead on policy areas, such as immunisation campaigns and elements of CQC inspection, and clinical topics such as diabetes. As NMC-registered nurses they have their own revalidation requirements, so will benefit from reflection, contribution to SEAs and participation in audit – all beneficial for the practice. Finally, ANPs have a wide role in terms of education. They are well placed to deliver tutorials to GP registrars, and medical and nursing students.

Employing an ANP

There are two options:

  1. Recruit a qualified ANP – if so, reflect on your needs, and how to package this in an exciting way to applicants.

ANPs are highly cost effective and are in high demand. The best will have their pick of practices; some struggling practices are offering salaries in the band 8C bracket, with enhanced leave and protected CPD time. As with GPs, locum work can be lucrative for ANPs, with rates in the region of £30-35. Commit to a package with a strong emphasis on support and development to persuade candidates that your practice offers the best option. There are no national financial schemes to support recruitment, although local schemes may be available, such as funding to provide further proactive care. Your CCG and LMC will advise.

  1. Train an existing practice nurse – this is a commitment in both GP time (supervision) and nurse time (study), which has an impact on practice finances as well as capacity.

That said, it can pay off in the long term. There are schemes that can provide financial support for the process, such as funding to replace the nurse on study days. This isn’t sufficient to fund locums for all the lost hours, but helps soften the blow.

Potential drawbacks

  • Making up time

If you are training of a nurse, you must replace the nursing hours you will lose once they graduate to the ANP role. This may be challenging, as practice nursing faces a workforce crisis of its own, with a projected 30% of primary care nurses planning to retire over the next two years4.

  • Keeping them on staff

There is also the risk that your new ANP may leave. It may be worth exploring this openly and seeking HR advice on your options. A strategy may be to foster a positive environment and to offer a competitive pay package in order to show your new ANP how much you value them.

  • Patient engagement

As is the case with other non-traditional job roles, it is vital to be transparent with patients about who they are seeing. Some patients can adopt a negative perception, but the vast majority should be receptive – and indeed, positive – once they have experienced the care an ANP can provide, and some may ask specifically to see them.

  • Indemnity issues

The role is not regulated separately and varies in nature from post to post, so indemnity can be a tricky issue. Explore the options for this. Your group practice cover might be the most cost-effective method.

Main points

  • Embrace non-GP clinical staff to meet workplace challenges.
  • ANPs can take clinical, non-clinical and management workload off GPs.
  • Consider training existing nursing staff to fulfil the role.
  • Expect some patients to resist change, but most will welcome the ANP.

  Further reading

  1. HEE General Practice Nursing Workforce Development Plan
  2. RCGP General Practice Foundation General Practice Advanced Nurse Practitioner Competencies. 2015

References

  1. Baileff, A The role of advanced nurse practitioners, Nursing in Practice 84; 19 May 2015
  2. Swann A, Ferguson S, Chang A, Larson E, Smaldone A (2015) Quality of primary care by advanced practice nurses: a systematic review, International Journal for Quality in Health Care 2015; 27: 396–404
  3. RCGP General Practice Foundation General Practice Advanced Nurse Practitioner Competencies. 2015
  4. Aston J (2018) The future of nursing in primary care. Br J Gen Pract 2018; 68 (672): 312-313

Is your practice looking to recruit? Contact Pulse Practice Jobs today to find out about our flexible advertising packages. Contact the team on 0207 214 0570 or email [email protected]

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https://pulse-intelligence.co.uk/guide/employing-an-advanced-nurse-practitioner/
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