I walk the corridors of most UK hospitals nowadays as an unknown entity. I go unnoticed as I mingle with the flocks of junior and middle-grade doctors during a ward round. I am indistinguishable due to my clinical camouflage of a stethoscope, pen torch and a (probably stolen) biro. I am neither doctor nor nurse; not a physiotherapist, operating department practitioner or paramedic. Yet my role can be all these things at once. I am an advanced clinical practitioner (ACP) and the role has been promoted as a novel solution to an age-old problem: chronic understaffing in healthcare.

ACPs are experienced healthcare professionals who are state-registered (eg nurses, physiotherapists, paramedics, pharmacists). We undergo a clinical and academic training period during which we tend to rotate specialities rather like foundation doctors, accumulating skills and knowledge along the way. This allows us to eventually work at a level commensurate with middle-grade medical colleagues.

I became an ACP because, in my former role, there was virtually no recognised clinical progression or potential for broadening one’s horizons. The opportunities in advanced practice, however, mean that I’ve had the opportunity to learn from academics and senior medical colleagues. I’ve also developed a set of skills ranging from taking blood to draining fluid from the abdomen, communicating bad news, and leading medical emergency team responses. My clinical scope has opened before me and I have thoroughly enjoyed exploring it.

The introduction of the role has been met with a mixed reception. When I was first appointed as a trainee ACP, one of my colleagues said witheringly: “Congratulations, you’re going to be an F1 [a very junior doctor] for the rest of your life.” While I admired the apparent wit of the comment, it struck me that my role is far from universally respected or well understood. Subsequent years of being called a “noctor” (not a doctor) and “demi-doc” have proved that point.

READ  Stomach bloating: Bloated stomach pain? You could have vitamin D deficiency study reveals

There are those who consider us to have abandoned our caring roots for the glamour of the medical team. There is no glamour in being so busy that neither a perilously full bladder nor ravenous hunger amount to reasons to stop and rest. Some consider us to be the paint over a catastrophic crack in a medical system that has been underfunded, ignored and abused for decades.

We aren’t around to replace doctors. It’s generally understood that being a middle-grade doctor is one of the hardest jobs in a hospital; they must also develop a learning and research portfolio too. ACPs can help shoulder the clinical burden, allowing our medical colleagues to spend time with their consultant, audit, study, and even relax. Overall, the idea is great, and we have an overtly positive impact on junior and middle-grade doctors’ working conditions.

The consultants and managers who understand the role see us as a vital bedrock for delivering high-quality care. Our pre-existing clinical maturity and newly developed skills help us fit in well with most departments, and patients respond very positively. They see us reliable and approachable clinicians focused on their wellbeing from both a medical and non-medical perspective.

It’s not all positive, however. Legislation bound to archaic healthcare practice and obtuse local policies have been frustrating ACPs along the way. Any changes are agonisingly slow to occur, and for no obvious reason tend to be half-measures. This only serves to confound colleagues, managers and patients alike.

Idiosyncrasies such as being able to request a radiation abundant abdominal CT scan but not being allowed to request a soft-tissue ultrasound are rife. ACPs are also unable to sign “fit-notes”, which stifles progression of highly-trained clinicians and is a further stumbling block to discharging patients from hospital.

READ  Parkinson’s disease - how much water should you drink to reduce symptoms?

Legal challenges such as what we can and cannot prescribe also plague ACPs. On many occasions I have happily and independently managed a patient through their hospital journey only to need a doctor to write the final prescription. A nurse ACP who does the exact same job as me, however, has the legal right to prescribe the drug.

It is hardly surprising that managerial and medical colleagues see these curious inconsistencies as flaws within the role. The truth is that we are equally as frustrated by these factors. There are plans to better regulate advanced practice for all professions regardless of their clinical setting. Until then I believe that we will continue to train ACPs only to lose them due to inconsistent and poorly implemented working conditions.

Not only will this be an expensive waste of everybody’s time, it will stifle healthcare evolution for the next few decades. For that reason I encourage all healthcare professionals and patients to unite in favour of ACP development. We are determined to assist in challenging working conditions, but we can only achieve this with the support of our colleagues and managers.

If you would like to contribute to our Blood, sweat and tears series about experiences in healthcare, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com



READ SOURCE

WHAT YOUR THOUGHTS

Please enter your comment!
Please enter your name here