Advanced Practice Toolkit 

12. Cost effectiveness and funding for the role 

TIP: Business cases for training roles should include training costs, costs associated with backfill for training time and supervisors, and practices should consider where backfill for specific roles and tasks could be found. 
Stewart Lord [42] argued that most practices viewed the Advanced Practice role as cost effective, both in terms of being paid a lower wage than a GP and in terms of improving access and so reducing the costs associated with patients becoming more complex over time. 
McDermott [28] found that one of the main motivations for funding an Advanced Practice post was to increase the availability of appointments, and that practices also discussed improving cost effectiveness. There is more detail on the impact that Advanced Practitioners can have, including in terms of more cost-effective care pathways, in the literature review that accompanies this paper [50]. 
Advanced Practitioners are sometimes viewed as a cheap alternative to GPs; Evans [10] et al quoted a practice manager who felt “forced into” recruiting Advanced Practitioners because they could “probably look to have two A[dvanced] C[linical] P[ractitioner]s for the price of a GP,” and quoted a practice manager who stated that an ANP [advanced nurse practitioner; sic] cost 50% of a GP and could do “75% of the same work;” it should be noted this practice manager was speaking in an interview and was not asked for hard figures to support this claim. Care must be taken with this message, as if Advanced Practitioners are viewed as “doctors on the cheap” this reduces their credibility with patients, undermines their specialist skills and can cause resentment amongst doctors. 
Cost-effectiveness arguments can be complicated by potential additional costs in terms of GP time to supervise, or, in some cases, a need for longer appointment slots. However, it is likely that positive patient impact outweighs the need for supervision. Training roles are more complex; someone who requires support through the masters will need paid study time, and their role may require backfill whilst the study continues. Again, these issues should not prevent an Advanced Practice role being a cost effective prospect but must be considered in business cases. Whilst securing funding for the actual course can be straightforward, money for backfill – and indeed staff for backfill – can be far harder to find [44; 45; 40; 42]. 
McDermot [28] found that most practices employing Advanced Practitioners did so without external funding from national or local bodies, with 73.7% of AP roles being funded without external support. 
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