The Advanced Practitioner in Primary Care (eBook)

Josey Coaten, Sarah Pay (Autoren)

eBook Download: EPUB

2025
662 Seiten
Wiley (Verlag)
978-1-394-25374-6 (ISBN)

Infos

Equipping Advanced Practitioners with the skills, insight, and confidence to lead in modern primary care

The Advanced Practitioner in Primary Care is a timely resource that provides current and aspiring Advanced Practitioners (APs) with a practical roadmap for delivering high-quality, patient-centred care in complex and fast-paced primary care environments. Built on the four pillars of advanced practice-clinical practice, leadership, education, and research-this text supports practitioners in bridging the gap between academic theory and clinical application.

Written by experienced clinicians and educators, this book is framed by national and international guidelines-applicable to adult, paediatric, and mental health contexts-and reinforced by real-world case studies that contextualise concepts and build confidence in managing diverse clinical scenarios.

Providing the structured support and evidence-informed guidance necessary for confident, competent, and reflective practice, The Advanced Practitioner in Primary Care:

• Covers complex consultation skills, clinical reasoning, systems-based clinical assessments, and decision-making with evidence-informed guidance
• Addresses the management of uncertainty and diverse patient presentations, including frailty and paediatrics
• Offers practical insights on getting the most from supervision and professional development pathways
• Includes a dedicated chapter on prescribing and medication management tailored for APs
• Discusses the evolving scope of the AP role in the context of local, national, and international policy

The Advanced Practitioner in Primary Care is essential reading for trainee and established APs working in primary care, as well as for nurses, paramedics, pharmacists, physiotherapists, and other professionals transitioning into general practice. It is also ideal for postgraduate programmes in advanced clinical practice and a valuable resource for educators and primary care teams supporting AP development.

Josey Coaten is a lecturer and Programme Director for the MSc Advanced Clinical Practice at the University of Hull. An experienced registered nurse and Advanced Clinical Practitioner, she is also a non-medical independent prescriber. Josey brings extensive experience from primary care, having held roles from practice nurse to Senior ACP. She holds a postgraduate certificate in academic practice and is a Fellow of AdvancedHE.

Sarah Pay has experience as a lecturer in the MSc Advanced Clinical Practice programme at the University of Hull and currently works as an ACP and clinical educator at Haxby Group. With a background in adult nursing, she has worked extensively in primary care as both a practice nurse and a Senior ACP. She is a non-medical prescriber and holds a postgraduate certificate in academic practice, as well as being a Fellow of AdvancedHE.

Textauszug

CHAPTER 1
Scope of Practice and Role Within Primary Care

Aim

The aim of this chapter is to summarize primary care along with the role and responsibilities of the advanced clinical practitioner within primary care in England. This will include the expectations, responsibilities, and demands of the role and how to provide safe and effective care within a primary care setting, while adhering to the four pillars of advanced practice, national guidelines, and to the practitioner’s own code of practice.

LEARNING OUTCOMES

On completion of this chapter, the reader will:

1. Comprehend the background and current concepts of primary care and the role this setting has within the wider healthcare sector.
2. Understand the expectations, roles, and responsibilities of an advanced clinical practitioner in primary care.
3. Gain an understanding of safe and effective practice within the primary care setting.
4. Comprehend indemnity and the importance of this.

INTRODUCTION

Advancing practice has a history dating back to the 1960s evolving in the United States of America and Canada and developing later within the United Kingdom (Barton and East 2015). The notion of advanced practice (AP) within the United Kingdom was exacerbated by the introduction of an education program for the Royal College of Nurses in London in the 1990s, this program was initially aimed at nurses within general practice and quickly expanded to other areas of healthcare (Sheer and Wong 2008).

AP is described by Health Education England (HEE) (2017) as a level of practice in which qualified healthcare professionals such as nurses, paramedics, pharmacists, physiotherapists, and occupational therapists are educated to a master-level standard of education. These professionals develop from a range of diverse backgrounds and will be experienced within their field of practice; this will enable them to expand their own scope of practice and benefit the needs of their patients. Advanced-level practice training and roles will encompass the four pillars of AP: clinical practice, leadership and management, education, and research (HEE 2017).

The National Health Service (NHS) long-term plan (NHS England 2023a) recognizes the importance of expanding the workforce and they aim to increase AP training places to 6371 by 2028. In enabling an increase, training places and funding will allow for the expansion of the NHS workforce overall, increasing access for patients, enabling career progression within the NHS, and increasing appeal of the profession.

CONCEPTS OF PRIMARY CARE

NHS England (2023a) expresses primary care as the first point of contact for patients into the healthcare system and encompasses general practice, dentistry, opticians, and pharmacy. It offers accessible care to the whole population and aims to provide continuous, comprehensive and patient-centered care (World Health Organization [WHO] 2024). Primary care is the gateway to other healthcare services and provides coordinated care for the whole person, enabling access to other healthcare provisions, gaining a deeper understanding around social prescribing, mental health, and personalizing care (NHS England 2023a).

ORIGINS OF PRIMARY CARE

Prior to the formation of the NHS, primary care was seen as general practitioners (GPs) who worked privately to supply healthcare to those who could pay. In 1948, the NHS formation prompted general practice to take responsibility for personal medical care and became the first point of contact and gateway to other specialist areas (Collings 1950). Primary care has developed significantly throughout the years, GPs no longer work in isolation and solely within single-handed practices but rather larger practices and working with the NHS. The way funding is allocated has also changed throughout the years. General practice acquires some funds through performance-related payments known as Quality and Outcomes Framework (QOF), which was introduced in the early 2000s, with an aim to improve health outcomes for patients. Later in 2011, general practices were required to register with the Care Quality Commission (CQC), which assures quality of care being delivered to patients (The Kings Fund 2011).

COMMISSIONING

In more recent years, the demand for primary care and general practice has increased and the reasons for this are multifactorial, some of which are an increasing and aging population and staff shortfalls. To combat this and to reduce the divide of community and primary care services and attempting to address health inequalities, the formation of integrated care services and primary care networks (PCNs) were formally established (NHS England 2023a).

Formally, Clinical Commissioning Groups (CCGs) were established as part as the Health and Social Care Act (2012) replacing primary care trusts; more recently, CCGs have been replaced by integrated care systems (ICS) within the Health and Care Act (2022). ICSs are regional partnerships that include the committees, boards, NHS, general practice, local councils, community, and voluntary sectors; their role is to establish and plan care across the regions and decide how best to deliver care services to meet the local needs, along with joining up care services to improve accessibility (British Medical Association [BMA] 2021). There are 42 ICSs across England each covering a geographical area; these are larger than PCNs and one of their roles is to manage PCNs to ensure they work together with a range of services to provide the highest quality of care which is accessible (BMA 2021).

PRIMARY CARE NETWORKS

There are 1250 PCNs across England typically each serving 30 000–50 000 patients within a community (NHS England 2023c). A PCN is a collaboration between GPs and other primary care services, enabling a greater provision for the patients and has been part of the NHS long-term plan for some time (NHS 2023). Bringing these practices together aims to relieve financial burden, improve staff recruitment and retention, and enable accessibility and more services for patients (NHS England 2023c). Expanding these services has enabled an expansion of the workforce and the introduction of expanded and enhanced roles for healthcare professionals (The Kings Fund 2011), therefore providing more opportunities for advanced clinical practitioners (ACPs) within this sector.

FUNDING

Funding for general practice and PCNs comes in many forms; they are generally funded in regards to services they offer, and each GP surgery must have and hold a contract to deliver services to patients and run as an NHS-commissioned service. Broadly, there are three types of contracts (see Table 1.1).

TABLE 1.1 Overview of GP contracts.

Source: Adapted from NHS England (2023d).

Contract	Negotiated

General Medical Services (GMS)

Negotiated Nationally and annually between NHS England, General Practice Committee and BMA for the delivery of core medical services.

Personal Medical Services (PMS)

Negotiated locally by NHS England and GP’s to tailor contracts to the local need.

Alternative Provider Medical Services (APMS)

This allows contracts with other organizations (Private) to provide a greater flexibility to the services offered.

In addition to the contracts, they have opportunity to make extra money by providing services. These are split into three categories.

Essential these are covered by baseline funding and are a must:

• Acute care (illness)
• Chronic disease management
• Care of the terminally ill

Additional can opt out of one or more but the funding will adjust accordingly, this covers:

• Contraception
• Minor surgery
• Out of hours services

Enhanced, this offers additional funding which includes PCNs contracts, which is directed enhanced services (DES), which covers elements such as:

• Healthcare checks for patients with a learning disability
• Extended hours
• Early cancer diagnosis
• Social prescribing (Healthcare Financial Management Association [HFMA] 2023)

QOF is voluntary for GPs; essentially, quality indicators may drive payment. Briefly, the framework indicators include management of chronic disease, management of public health concerns (obesity, smoking), and screening (blood pressure checks) (NHS England 2023d).

ROLE OF THE ACP IN PRIMARY CARE

Primary care has a wide range of practitioners within the workforce, including ACPs who are expert within the field of generalist medicine (NHS England 2016). ACPs will aid in the provision of care of the growing and aging population; they have a specific role in the management of a range of patients from birth to death (NHS England 2016). The day-to-day role of an ACP in primary care will range from consulting with patients with an acute presentation, management of chronic health conditions (diabetes, chronic obstructive pulmonary disease, asthma, hypertension, chronic heart disease), preventative care, education, advice, health promotion, support, and empowerment of patients and care of the patient within their own homes (WHO 2024). The ACP will be required to develop a range of consultation skills ranging from face to face, remote, and video consultation (HEE 2020). With consideration of this, the ACP working within this sector will require a specific and...

Produkt-Details

• Erscheint lt. Verlag: 30.12.2025
• Reihe/Serie: Advanced Clinical Practice
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Pflege
• Schlagworte: ACP assessment • ACP career development • ACP case studies • ACP history taking • ACP patient centred care • ACP prescribing • ACP primary care • advanced clinical practice • advanced clinical practitioner education • advanced practice • advanced practitioner consultation models • AP primary care
• ISBN-10: 1-394-25374-5 / 1394253745
• ISBN-13: 978-1-394-25374-6 / 9781394253746