References
Advanced nurse practitioner experiences of referrals
Abstract
In recent years primary care services in Scotland have increasingly employed advanced nurse practitioners (ANPs) to undertake roles that were traditionally fulfilled by GPs. The aim of this study was to explore the experiences of ANPs in primary care settings making independent referrals following a holistic advanced clinical assessment. A focus group interview was undertaken with five ANPs from one health board area in April 2023. The findings were themed into three principal areas: preparation for the role, communication and gate keeping. These three key areas were reported to result in a number of negative feelings and emotions for the ANPs. Recommendations from this study include the need to ensure ANPs are prepared to make independent referral, have independent access to make referrals, that colleagues understand the skill and autonomy of the ANP and that ANPs are offered regular restorative clinical supervision.
Primary care services, globally, are facing a number of challenges in the way health care is delivered to the public. Within Scotland, in 2023 there were more than 300 whole-time GP vacancies (British Medical Association (BMA), 2024). GP shortages and increasing workload resulted in the negotiation of the General Medical Services Contract (Scottish Government, 2017a). As a result, multidisciplinary teams, which include ANPs, were developed to support the workload of the reducing GP workforce. The Scottish Government and the Chief Officer for Health and Social Care Scotland requested that Health and Social Care Partnerships, through Primary Care Improvement Plans, develop new models of care, where ANPs provide a first response to people requesting a home visit (Scottish Government, 2017a).
Simultaneously, the Scottish Government Chief Nursing Officer Directorate published a number of policy documents describing a programme of work referred to as Transforming Roles (Scottish Government, 2017b). These documents provided clarity around the education and governance of nurses who would be undertaking these advanced roles. Two papers, relating specifically to ANP roles (Scottish Government, 2017c; 2021), described the autonomy ANPs have in making senior clinical decisions including the ability to refer to all appropriate health professional groups and agencies. Internationally, the International Council of Nurses (ICN) (2020) argued that advanced practice nurses provide timely care, working in partnership with patients, families and carers.
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