Advanced Practice Toolkit 

7. Dealing with professional isolation 

TIP: Encourage Advanced Practitioners time to access professional and personal networks for support. 
Peer and professional networks are a key element of support for Advanced Practitioners [48], and can work towards mitigating issues of geographical isolation in primary care and rural areas [48; 11]. Recognising that peer support can often be provided through leadership, Nottinghamshire has a Primary Care Advanced Practice Lead but a formal leadership structure does not exist at place or partnership level. 
Our focus groups [25] highlighted that primary care could be “isolating”, with only one Advanced Practitioner in the practice and little opportunity for peer-to-peer support. They highlighted that Advanced Practitioners were not GPs and that there was a “gap” of specific competencies between Advanced Practice and GPs that Advanced Practitioners were sometimes expected to bridge; “the competencies that we don’t see often enough to pick up in daily practice, we need something in that gap.” People were keen to share resources, but felt that good quality primary care resources could be hard to find and that a directory of information and relevant training could be very valuable; “right now we have to know someone to ask.” Specific resources such as Red Whale¹, aimed at GPs, was highlighted as a good model; content was seen as hard to access if it was too dispersed. Not every attendee had heard of the Nottinghamshire Alliance Training Hub (NATH) or understood what it could offer; NATH is working to improve its access through apps such as GrowNotts Primary Care, and other communications. 
Professional networks can be a useful form of support for Advanced Practitioners; this can involve face to face, or via closed forums on social media or apps like WhatsApp [11; 25; 48]. Focus groups in Nottinghamshire [25] found that participants felt that there was an over reliance on individual supervisors for support and that peer led spaces could be more innovative for problem solving and that there was also a role for communities of practice and expert support from individuals beyond their employer. 
Consideration could be given to place and/or partnership based advanced practice leadership that then could provide additional support to individuals and employers. 
¹Red Whale is a commercial lifelong learning resource aimed at GPs. It does not currently offer training for other professionals, and we have not evaluated it so are not endorsing it. It is mentioned here as a quote from our focus groups purely as an example of an easy to use, online resource that provides a model that people would like to be able to access. Red Whale Homepage 
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