Primary care is the backbone of the care system – it is what patients need and value the most. As GPs we should be thinking of optimal care delivery by exploring new ways of delivering care, planning for the future and making the best use of skill mix.
Improving patient access to primary care is a big challenge. Practices spend huge sums on locum costs and an alternative is to look at managing demand more efficiently.
In our practice there was a storm when one of the GPs decided to take a well-needed, four-week annual holiday. Could the remaining partners cover the workload, could the practice afford a locum GP? Should the practice cancel some regular clinics or ask the attached medical student not to come?
Two clear answers were: the practice could not cancel any of the services it provided and we could also not afford a locum GP. So, we decided to get a locum advanced nurse practitioner (ANP) instead of a locum GP.
What is an advanced nurse practitioner?
An ANP is a registered nurse who has additional education and training, which may include extra training in a speciality area such as family practice, respiratory, sexual health or cardiology.
ANPs have a master’s degree in nursing and certification in their speciality. They are also able to prescribe independently.
The post was advertised to cover the GP’s annual leave. We conducted an interview, checked references and qualifications and then employed the ANP to join our team.
There are relatively few qualified ANPs in general practice in the Oldham area, but we were lucky enough to find one. This meant she was up to date with local policies, prescribing guidelines, blacklisted drugs and antibiotic prescribing guidelines
What tasks did the ANP undertake?
- Triage: Many patients request same-day appointments, often for self limiting conditions, social advice and health education. By undertaking a triage role she provided a highly effective service.
- Diagnosed and treated acute illness, infections and injuries, including URTI, tonsillitis, otitis media. chest infections, UTI etc.
- Conducted physical examinations after taking a proper history and liaised with the GP as and when necessary.
- Performed monitoring of chronic diseases, including diabetes, asthma, CKD and hypertension.
- Interpreted lab results and took actions.
- Prescribed and reviewed medications as per guidelines.
- Provided family planning services: advice on late/missed pills, morning after pill, missed/late depo and conducted smears if indicated.
- Provided baby immunisation and opportunistic flu and pneumococcal vaccinations.
- Counselled and educated patients on health behaviours, self care and over the counter medications.
- Collaborated with GPs and other health professionals as and when needed.
- Admitted patients after discussing with on call registrar.
- eferred patients via Choose and Book.
Why we would use a locum ANP in future
The ANP worked well in our practice. Over a four-week period of working 16 hours a week a total cost saving of 33% was made, compared to employing a locum GP for the same period.
With practices having to pay GP locums’ employer superannuation contributions from April, the savings going forward are likely to be even greater.
A patient satisfaction survey and follow-up interviews with some of the patients showed that they were satisfied with the ANP’s consultations.
- Relevant QOF information was completed at the time of consultation e.g. height, weight, BP, urine analysis, smoking history.
- Smear tests on women requiring them were done opportunistically (a locum GP would not provide this).
- All referrals, including referral to community clinic, were done and not left for the GP to do the next day.
- No mileage was paid from base to work and back (all locum agencies charge mileage).
- The home visits would have been done at no extra cost (locum GPs charge more for visits).
- Opportunistic baby immunisation was also undertaken.
With much less money available now and in future we need to pay close attention to practice expenses, while ensuring that we provide a quality service. Recruiting a locum ANP helped us to meet these objectives.
- Dr Sharma is a GP in Oldham, Greater Manchester