The concept of advanced nursing practice has existed in the US since the 1960s and in the UK since the early 1980s. The first signs of the advanced nurse practitioner (ANP) emerged in Ireland in the late 1990s in response to increasing demands and changes occurring within nursing as a discipline and throughout the national healthcare system. The ANP role was eventually established in 2001 and represents a vital development within Irish healthcare. The role of the ANP in general practice (GP ANP) has grown and evolved since the first GP ANP accreditation in 2005, and is a unique generalist nursing specialism.
The evolving and extensive role of the GP ANP in Ireland
Today, general practice incorporates many members of the multidisciplinary team, ranging from GPs, general practice nurses, nurse prescribers, healthcare assistants, phlebotomists, and more recently, ANPs. The introduction and development of the role of the GP ANP has already been a viable solution to many of the challenges general practice continues to face, such as an increasingly complex and ageing patient population, declining GP numbers, and rapidly expanding workloads. Like general practice nurses, GP ANPs are becoming pivotal in responding to these increasing demands within GP services, and strongly reinforce the Sláintecare healthcare policy of “providing the right care, in the right place, at the right time”. Overall, GP ANPs represent an exciting and innovative additional healthcare service in the general practice setting. Currently, there are 20 registered GP ANPs in Ireland, with approximately 21 further candidates in training.
“A nurse practitioner/advanced practice nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills, and clinical competencies for expanded practice, the characteristics of which are shaped by the context and country in which s/he is credentialed to practice. A Master’s degree is recommended for entry-level.”
(International Council of Nurses – 2019)
In Ireland, nursing professionals make up 45 per cent of the clinical workforce in general practice, which is a significant number (Irish College of General Practitioners, 2022). The primary difference concerning the professional profile of an Irish registered ANP and a registered general nurse is that an ANP is educated to Master’s level (minimum Level 9 on the National Framework of Qualifications).
The GP ANP has the full skill set to complete an entire episode of patient care independently, and spends extensive clinical hours practising at an advanced level in their area of practice. Health assessment modules enable the ANP to perform comprehensive health assessments and physical examinations. They must be an authorised nurse prescriber and also have authority to refer to other healthcare professionals and departments, ie, emergency departments, medical assessment units, consultants, outpatient clinics, and integrated care hubs. Several GP ANPs also have the authority to refer for radiological procedures.
GP ANPs are competent and capable of providing services to a wide and varied mix of general practice patients because of their wide-ranging education, training, and skills. The GP ANP’s caseload is identified at the local level between the practitioner and GP, and is dependent on the individual practitioner’s experience and scope of practice. Caseload examples would generally include the management of chronic diseases, sexual health, women’s health, acute minor illness, early intervention, and preventive treatments.
Implementation and development of the GP ANP has proven to be a very successful model of care internationally in many countries, with ANP-led care leading to enhanced disease prevention in the community, improved continuity of care, improved GP access, and significant reductions in hospital admissions, among myriad other positive outcomes. GP ANPs represent an exciting, cost-effective, and innovative additional healthcare service in general practice; the effects of which extend beyond primary care and across the spectrum of healthcare as a whole.
GP ANP Ireland
The enthusiasm within the Irish GP ANP community to make a difference in practice and patient care is palpable, and has resulted in the establishment of GP ANP Ireland – the first formal association of GP ANPs in the country. Members of the group describe the role of GP ANP as “dynamic” and “extremely rewarding”, but also one that “is not without its challenges”. It is a role “filled with pride”, and it is a role that “lacks acknowledgement and recognition for its contribution to healthcare in Ireland”.
“GP ANPs are integral to the future development of general practice to respond effectively and efficiently to the evolving and dynamic healthcare needs of individual patients, communities, and government policy. To fully support and foster the GP ANP role, there needs to be the necessary support at Government level to develop and progress the position by promoting awareness and recognition, supporting funding and education, and access to services and interventions afforded to our flourishing secondary care, HSE colleagues.”
GP ANP Ireland was established in 2023, and since then, committee members – Pamela McCann; Orla Loftus Moran; Melissa Hammond; Carol Kelly; Catriona Keys; Louise Nolan; Jane Deehan; and Katy Lynch – have been working extremely hard to gain the vital recognition, support, funding, and education GP ANPs require to develop the role to its full potential. Although evolution of the role is in its infancy, GP ANP Ireland has been systematically gathering and analysing data that demonstrates a profoundly positive correlation between ANP-led care provision and patient outcomes in primary care to support its campaign. The group has received much welcomed support from Professional Development Coordinator (PDC) Marie Cantwell and her fellow PDCs for GPNs.
GP ANP Ireland’s vision
“To lead expert advanced nursing care, enabling optimal outcomes for our patients in general practice. We endeavour to provide holistic, collaborative, patient-focused care, which reflects core nursing values of care, compassion, and commitment. These values are aligned with our objectives to foster a culture of recognition, advocacy, and inclusion for advanced nursing in general practice.”
Progress so far
Members have been meeting and collaborating with key individuals, stakeholders, and governing bodies across the country, including the Irish College of General Practitioners, the Nursing and Midwifery Board of Ireland, the Irish Nurses and Midwives Organisation, the Irish Association of Advanced Nurse Midwife Practitioners, and the Irish General Practice Nurses Educational Association, to generate much needed recognition and support for development of the GP ANP role. The group is also engaging at Government level with Minister for Health Stephen Donnelly, Chief Nursing Officer Rachel Kenna, and HSE CEO Bernard Gloster, and has been invited to produce a submission on the Strategic Review of General Practice by the Department of Health.
You can contact GP ANP Ireland by email at gpanpireland@gmail.com.
All members of GP ANP Ireland can be located at: www.google.com/maps/d/editmid=18PuKmrdgFtFdqPlPUVKV5tVF1DbFu6Y&ll=53.09040058166971%2C-7.844173499999995&z=8.
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