School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK.
NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2HA, UK.
Int J Environ Res Public Health. 2020 Jun 23;17(12):4500. doi: 10.3390/ijerph17124500.
Escalating costs and changing population demographics are putting pressure on primary care systems to meet ever more complex healthcare needs. Non-medical 'advanced clinical practitioner' (ACP) roles are increasingly being introduced to support service transformation. This paper reports the findings of a qualitative evaluation of nursing ACP roles across General Practices in one region of the UK. Data collection involved telephone interviews with 26 participants from 3 different stakeholder groups based in 9 practice sites: ACPs ( = 9), general practitioners ( = 8) and practice managers ( = 9). The data was analysed thematically. The study found a high degree of acceptance of the ACP role and affirmation of the important contribution of ACPs to patient care. However, significant variations in ACP education, skills and experience led to a bespoke approach to their deployment, impeding system-wide innovation and creating challenges for recruitment and ongoing professional development. In addition, a context of high workforce pressures and high service demand were causing stress and there was a need for greater mentorship and workplace support. System wide changes to ACP education and support are required to enable ACPs to realise their full potential in primary care in the UK.
不断上升的成本和不断变化的人口结构，给初级保健系统带来了压力，使其需要满足日益复杂的医疗保健需求。为了支持服务转型，越来越多的非医疗“高级临床医生”（ACP）角色被引入。本文报告了对英国一个地区的全科医生中护理 ACP 角色的定性评估结果。数据收集涉及对来自 3 个不同利益相关者群体的 26 名参与者进行电话访谈，这些参与者分别来自 9 个实践地点：ACP（=9）、全科医生（=8）和实践经理（=9）。数据进行了主题分析。研究发现，ACP 角色得到了高度认可，并且肯定了 ACP 对患者护理的重要贡献。然而，ACP 教育、技能和经验的显著差异导致了他们的部署采用了定制方法，阻碍了系统范围的创新，并为招聘和持续的专业发展带来了挑战。此外，高劳动力压力和高服务需求的背景导致了压力，需要更多的指导和工作场所支持。需要对 ACP 教育和支持进行系统范围的改革，以使 ACP 能够在英国的初级保健中充分发挥潜力。
