In-hours acute home visits by advanced nurse practitioners in primary care: a qualitative study
The extension of roles within the primary care team is one approach recommended to address the shortage of GPs in the UK. A key aspect of care that advanced nurse practitioners (ANPs) can undertake is acute home visits.
To evaluate the perspectives of ANPs performing acute in-hours home visits in primary care.
Qualitative data were gathered in eight semi-structured interviews across a primary care locality, then analysed via a process of thematic analysis.
Three key themes were identified: providing holistic care; engaging with the home setting; and negotiating role ambiguity.
Practices wishing to involve ANPs in acute home visits should ensure clear definition and good understanding of the ANP role. Effective interprofessional relationships should be fostered with appropriate mentorship and clinical supervision to support ANPs in optimising their contribution to acute home visits.
Primary care advanced nurse practitioners (ANPs) are health professionals who can make autonomous decisions about patient diagnosis and screening, order tests and investigations, prescribe, refer to other services such as secondary care and work with other primary care professionals to provide patient care (Royal College of Nursing (RCN), 2018). ANPs are now working widely as ‘doctor substitutes’ in primary care, and this substitution is considered a promising model worldwide (Van der Biezen et al, 2016). It has been highlighted that general practice is in crisis due to a growing workload uncompensated by any increase in funding or workforce (Baird et al, 2016). General practice is delivering care under significant pressure, not just in the surgery setting, but also in patients' private homes and residential/nursing care facilities. As the general practice workload has increased with an emphasis on carrying out more care out of hospital (NHS England, 2014), the ANP role within general practice has been expanding from chronic disease management to cover more elements of acute care.
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