Advanced Nurse Practitioners (ANPs) are registered nurses who have undergone advanced training and gained additional qualifications, enabling them to assess, diagnose, refer, and treat patients with undiagnosed or complex health issues.
These highly skilled professionals are capable of performing in-depth patient assessments, much like General Practitioners (GPs). They can evaluate symptoms, develop a comprehensive understanding of a patient’s condition, and provide treatment for a variety of minor health concerns, including infections, minor injuries, and prescribing medications when necessary.
ANPs are also equipped to manage more complex medical conditions, such as chronic illnesses like diabetes and chronic obstructive pulmonary disease (COPD), providing ongoing care and support for patients with long-term health needs.
What can advanced nurse practitioners help with?
- complex patient reviews/assessments
- diagnosing acute and chronic conditions
- treatment of minor illnesses
- prescribing and reviewing medication
- advising on prescribed medication
- evaluating treatment plans
- managing conditions holistically
- ensuring joined-up call for all patients
How does the role of an advanced nurse practitioner differ from that of a practice nurse?
Advanced Nurse Practitioners (ANPs) come from a diverse range of clinical backgrounds, including both primary and secondary care settings. As a result, their skills and training can vary significantly.
ANPs are equipped with generalist skills, but many also develop a special interest or expertise in particular areas of care, such as conducting assessments and reviews for patients with long-term conditions like diabetes.
ANPs are skilled in gathering patient histories, interpreting diagnostic test results, and formulating care plans to deliver appropriate treatment. Their advanced capabilities often allow them to take on roles traditionally handled by GPs, providing valuable support to primary care teams and helping to reduce pressure on the healthcare system.
Furthermore, all fully qualified advanced nurse practitioners can prescribe medication for any condition within their competence.
How can patients book to see or access advice from an advanced nurse practitioner?
Patients can book an appointment by contacting their practice via an online consultation or by telephone.
Patients will see an Advanced Nurse Practitioner (ANP) in a similar manner to how they would see their GP, typically in a private consultation room. If an ANP assesses a patient and determines that further clinical expertise is required, the patient will still have the option to see a GP for additional support or specialised care.
The ‘Additional Roles Reimbursement Scheme’ (ARRS) brings colleagues from a wide variety of clinical disciplines (e.g. pharmacists, physiotherapists, social prescribing link workers, mental health practitioners, occupational therapists, advance nurse practitioners) into core General Practice teams.
Dr Veronica Devereux and Dr Shivangi Thakore share the role of ARRS champion (Educational Lead) to support these colleagues for the N1 Primary Care Network (PCN). They are both experienced GPs – Dr Devereux has worked in North Islington for over 20 years and Dr Thakore for over 15 – and have been involved with the N1 PCN since its inception. They are both passionate about education and supervision in General Practice. Dr Devereux is a GP trainer, appraiser and mentor, Dr Thakore has led undergraduate medical student placements in primary care for years as well as been involved in innovation and introducing new roles (practice based pharmacist, advance nurse practitioner) into Practice long before these became the norm.
Additional Roles are still relatively new to General Practice; the ARRS Champion role is to actively support ARRS colleagues to become fully embedded in Practice teams and to be understood and valued by existing General Practice staff and patients. The current General Practice workforce and model is entirely dependent upon ARRS colleagues. Supporting ARRS colleagues to fully integrate and flourish in General Practice, and outside of their traditional work environments/structures, is central to their satisfaction and retention (in turn leading to high quality clinical care and continuity for patients). The relationships and knowledge of our communities, which we build over time, underpin job satisfaction in General Practice; part of the role ARRS Champion Role is to facilitate ARRS colleagues to become the lead clinician for some patients (where optimal for the patient) and build these relationships in the same way GPs do.
We work closely with our PCN Clinical Director and practices to ensure we are aligned and all working collaboratively to:
- Nurture a culture of education, development and peer support in our PCN
- Ensure practices have a good understanding of the importance of clinical and professional supervision and evidence that this is implemented
- Ensure that all ARRS staff have a meaningful annual appraisal incorporating a Personal Development Plan
- Organise pan PCN learning events for all our PCN staff informed by an educational needs assessment
- Encourage cross cover and mutual support for our teams across PCN practices as this fosters improved resilience for all PCN Practices.
- Work with approved educators across our PCN practices to ensure we are nurturing the next generation of GPs, pharmacists, and primary care colleagues within Islington to continuing offering the best care to our community.
- The ARRS champions will have significant insight into the local workforce development needs and will communicate these to NCL and Islington Training Hub. This should allow sharing of best practice and increase the quality of educational opportunities within primary care
About Physiotherapists in General Practice
Musculoskeletal (MSK) conditions, including back pain, muscle aches, and joint problems, are among the most common reasons people make repeat visits to their GP. These issues account for approximately 20% of all GP appointments. In many cases, a physiotherapist can effectively address these problems without the need for a GP consultation.
Research indicates that physiotherapists are the leading experts in managing musculoskeletal issues, second only to orthopaedic specialists. They have an excellent safety record, comparable to that of GPs. In addition to their expertise in rehabilitation and pain management, some physiotherapists are trained to perform steroid injections, request diagnostic tests such as scans, and even prescribe medications.
Who the Physiotherapists can see:
Inclusion Criteria:
- Adults aged 18 and over
- All soft tissue injuries, sprains, strains or sports injuries – upper and lower limb
- Arthritis – any joint
- Possible problems with muscles, ligaments, tendons or bone
- Spinal pain including lower back pain, thoracic pain and neck pain
- Spinal pain including arm/ leg symptoms +/- neurological symptoms, for example pins and needles and numbness
- Mobility deterioration of non-house bound patients relating to MSK conditions
- Post orthopaedic surgery
Exclusion Criteria:
- Acutely unwell
- Children under 16 years of age
- Medical management of rheumatological conditions
- Non MSK women’s health (antenatal and postnatal)
- House bound patients
- Medication reviews
- Neurological and respiratory conditions
- Headaches
- Acute mental health crisis
- Patients who do not want to see a FCP
How Are GPs Benefiting?
Physiotherapists play a key role in helping GPs manage their workload more efficiently. By handling appointments for patients with musculoskeletal (MSK) conditions, physiotherapists reduce the need for GP consultations and prevent unnecessary referrals to secondary care. This helps ease the pressure on specialist services, including orthopaedics, pain management, rheumatology, community physiotherapy, and Clinical Musculoskeletal Assessment and Treatment services. As a result, GPs can focus on other areas of patient care, improving overall service efficiency.
What Are the Benefits for Patients?
- Faster Access to Expert MSK Care: Patients receive quicker assessments, diagnoses, treatments, and advice from MSK specialists.
- Prevention of Long-Term Conditions: Early intervention helps prevent short-term issues from developing into chronic conditions.
- Enhanced Patient Experience: With more streamlined care, patients benefit from a smoother, less fragmented treatment journey.
- Fewer Appointments: A more direct pathway to care means patients typically need fewer visits, saving them time and hassle.
- Simplified Logistics: With a clearer care pathway, patients are less likely to miss appointments or experience administrative errors.
- Access to Lifestyle and Activity Advice: Physiotherapists offer expert guidance on maintaining a healthy lifestyle and staying active, tailored to the patient’s needs.
- Longer Appointments: Patients have more time during consultations, allowing them to feel heard, valued, and reassured throughout their treatment.
A Primary Care Specialist Mental Health Practitioner is a skilled professional with experience in supporting individuals experiencing mental health issues, whether diagnosed or not. These practitioners operate within our Primary Care Network (PCN), offering early assessments and treatment interventions for those with mental health conditions, as well as providing guidance, signposting, and additional resources when necessary.
Serving as the first point of contact for adults dealing with mild to moderate mental health concerns, they aim to improve the patient experience by fostering better collaboration between Primary Care and Specialist Community Mental Health Services (SCMH). This collaborative approach ensures that patients can access the right care, at the right time, from the right professional.
The practitioner conducts comprehensive assessments and offers immediate support, while also referring patients to appropriate local services for ongoing care. Additionally, they can consult with GPs to initiate medication without requiring the patient to see the doctor in person.
Working as part of a multidisciplinary team (MDT) within the PCN, the Primary Care Specialist Mental Health Practitioner collaborates with other healthcare professionals—such as clinical pharmacists for medication reviews and social prescribing link workers for community-based support—to address the wide range of biopsychosocial needs that may arise for patients with mental health challenges.
What is an Occupational Therapist?
Occupational Therapists (OTs) are registered healthcare professionals with expertise in both physical and mental health, and a deep understanding of how social factors influence overall wellbeing. They specialise in evaluating how illness or injury affects a person’s ability to perform everyday activities.
In Occupational Therapy, the term “occupation” refers to any activity that an individual engages in which is purposeful, meaningful, and repetitive, and that the person perceives as an important part of their life. These activities can include work, hobbies, self-care tasks, and social interactions.
Occupation engages all aspects of a person—physical, psychological, and social—and can be a powerful tool for transformation when used in therapy to address specific challenges in daily living. OTs help individuals regain independence and improve their quality of life by focusing on these activities.
Appointments with Occupational Therapists are typically offered either by phone or in person, depending on the patient’s needs and circumstances.
What can our Occupational Therapists assess?
Any functional difficulties impacting health and/or quality of life. OTs can deliver assessment and intervention for a broad range of conditions including:
– Memory problems
– Frailty
– Fatigue
– Pain Management
– Sleep Disturbance
– Vocational Rehabilitation (Stress/anxiety/advise on reasonable adjustments relating to work)
– Mental Health Assessment
What can paramedics offer?
Paramedics play a valuable role in general practice, drawing on their expertise in pre-hospital care to work with patients across a wide range of health conditions—from minor issues like coughs and injuries to more serious conditions such as asthma and heart attacks. They collaborate with GPs to manage both routine and urgent appointments, provide telephone triage (assessing the urgency of illness or injury), and conduct home visits.
In primary care, paramedics are able to:
– Assess and triage patients, including same-day triage, and provide treatment as appropriate.
– Offer general healthcare advice and support self-management for patients.
– Perform specialist health checks, conduct ECGs, carry out investigative procedures, and even take blood samples.
When faced with more complex clinical issues, paramedics can consult with a GP or other specialists to ensure the patient receives the most appropriate care.
How do they support GP practices?
Paramedics help to free up GP time by managing patients with less complex medical needs and providing home visits during the day. Their specialist skills and knowledge are particularly valuable for urgent home visits, ensuring that patients receive timely care when needed.
In addition to visiting patients at home, paramedics can assist in the surgery or offer advice over the phone. By providing these services, practices can allocate more time for home visits, often preventing the need for further treatment or hospital visits, and helping to streamline care.
How do I access support from a paramedic?
When you contact your GP practice, they will direct you to the most appropriate professional for your needs. They may offer a callback to assess the support required or, if needed, send a paramedic to your home—especially for patients who are unable to visit the surgery in person.
A Patient Participation Group (PPG) is a group of patients who collaborate with local healthcare providers to enhance the quality of health services in their area. Composed mainly of volunteers registered at a specific GP practice or healthcare centre, PPGs meet regularly to discuss healthcare concerns and propose improvements to the services offered.
PPGs serve as a voice for patients, providing feedback and offering suggestions on how healthcare providers can better meet patient needs. Additionally, PPGs may organise events and initiatives aimed at promoting healthy living and supporting individuals with specific health needs.
North 1 PCN’s Patient Participation Group
Each of the practices within N1 PCN hold patient participation group meetings twice a year. As a PCN, we also hold pan-PCN meetings twice a year.
We aim to involve as many patients as possible from across all our practices on a voluntary basis, so we can shape and improve the services we provide. We are seeking volunteers who are open to being contacted periodically to share their views and possibly attend our PPG meetings.
If you would like to take part in future meetings, please contact your practice and let them know.
North 1’s Pharmacy Team aims to improve outcomes for patients through structured medication reviews and shared decision making, working closely with patients to embed personalised care plans and optimal medication regimes.
The patient populations we focus on include care home patients, frail patients, patients with multiple long-term conditions including cardiovascular patients (such as those with high blood pressure, high cholesterol, atrial fibrillation, heart failure and post-MI patients), diabetes patients, patients with kidney disease, patients with severe mental health and learning difficulties and respiratory patients.
Our Pharmacy Technicians work with patients who have had a hospital stay or multiple medicines changes to support them after discharge, ensuring a seamless transition of care. They carry out safety audits and support our dedicated care home Pharmacist with all aspects of medication reconciliation for care home patients. We have a prescriptions clerk who supports our technicians and pharmacists with safety audits, care home administrative work, arranging rotas and processing clinical documents. We are also a teaching team. We supervise and mentor both trainee pharmacists and trainee pharmacy technicians.
The team follows best practice and works closely with all practices across the PCN to support with any complex medication queries and medication reviews to ensure we are consistently delivering a high standard of care to all our patients. The team also work closely with practice pharmacists ensuring as a team we provide the best possible patient care.
About social prescribing link workers
Patients visit their GPs for various reasons, and sometimes these concerns stem from non-medical issues such as loneliness, stress, unemployment, financial struggles, or family challenges. Social prescribing link workers collaborate with GP practices to connect individuals with the right support services in the community, helping them make positive changes to their overall wellbeing.
How can social prescribing link workers assist patients?
Social prescribing link workers provide support and guidance on a wide range of non-medical issues, including:
– Coping with chronic conditions that don’t have a clinical solution
– Mental health concerns and emotional wellbeing
– Relationship difficulties
– Domestic abuse
– Loneliness and social isolation
– Low self-esteem
– Housing problems
– Financial difficulties, including benefit support
– Support for carers
– Bereavement
– Health-related goals such as weight management, healthy eating, smoking cessation, and increasing physical activity
How are GP practices benefiting?
Social prescribing offers GP practices, nurses, and other healthcare professionals the ability to refer patients to a variety of local, non-clinical services that support their health and wellbeing. Often, personal issues such as social isolation or financial stress can lead to conditions like depression, which in turn leads people to seek medical help. By addressing these underlying social issues, social prescribing can help patients feel more empowered, which may reduce reliance on medication and result in fewer visits to the GP.
How can patients access a social prescribing link worker?
Social prescribing is available to adults (18+) who present at their GP with concerns that are primarily non-medical. These may include social needs, ongoing health conditions, frequent visits to the GP, or risk of unplanned hospital admissions.
Once referred by their GP, patients meet with a social prescribing link worker at their practice. The link worker then assesses their needs and directs them to the most suitable local services or support. The referral process is personalized to address the patient’s specific needs, which could range from practical support for finances or housing to resources for managing social isolation.
By treating patients holistically, social prescribing aims to improve their overall quality of life and help them regain control over their health and wellbeing.