Advanced Practice Toolkit
10. Working with patients
TIP: Ensure that reception staff are clear about the specific skills and advantages offered by the AP and can communicate this to patients.
TIP: Create and patient information resources to support advanced practice.
Evans et al [10] considered patient acceptability as the greatest barrier to the development of Advanced Practice roles. Several studies highlighted that patients in Primary care still expect to see a GP and that other professionals are seen as lesser or as being “fobbed off”, even where that professional may be more expert than the GP in that specific area or task [23; 32; 49]. Nelson highlighted a role for receptionists in understanding the Advanced Practice role and conveying this understanding to patients [32]. Mc Dermot et al [28] found that there is a negative correlation between the number of non-medical staff in a practice and the patient satisfaction with making an appointment and overall satisfaction with the practice; they suggest this might be due to the “complexities associated with categorisation and matching” (i.e. triage by a receptionist). They state that “patients are generally accepting” of non-medical staff but that implementation cannot be viewed as a straightforward benefit due to the risks of “mismatching” – presenting with a problem that looks as though a specific Advanced Practitioner can help but which later emerges as different or more complex. They report that patients do not always understand non-doctor roles and skills. However, they also note that the situation is “dynamic” and that the problems they highlight may be a feature of the early stage that Advanced Practice and other new roles are at. They argue patients like seeing Advanced Practitioners when that means faster access, longer appointment times or better continuity of care. Evans et al suggest a national media campaign focusing on the skills within the practice, rather than on the role of GPs alone.
Our participants [25] told us that if Advanced Clinical Practitioners were not there, waiting times would increase or patients would not be able to access care in the practice, and many attendees felt that patients were beginning to understand that.