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What is the challenge your project is going to address and how does it connect to your chosen theme?

England has an aging population and workforce shortages. One solution has been the widespread implementation of  the ACP role, however there is significant variation in scope of practice and support (King et al, 2017). Evidence from an ACP facebook group of almost 6000 members reveals that some ACPs undertake visits to care homes as part of their role. There is a lack of research evidence on how ACPs work in care homes (scope of practice and models of care) and the impact on patient outcomes, utilisation of primary care services, and referals to secondary care. My recent PhD explored advanced nurse practitioners discharge decision-making.  This, in addition to my previous clinical role as a primary care ANP has provided an in-depth understanding of the issues around role implementation and support.

Previous research into this subject has been undertaken in Australia, Canada and the USA (Intrator et al. 2015, Dwyer et al. 2017, McAiney et al. 2017, Arendts et al. 2018), not the UK.

What does your project aim to achieve?

The objectives of this study are to understand the scope of the primary care ACP role in visiting care homes, and the impact that role has from the perspectives of  key stakeholders (ACPs, commissioners, care home managers, relatives, and residents). Interviews will be used to collect data, by telephone or face to face (dependent on the preference of participants).

In light of the pressures experienced by the National Health Service, including workforce shortages, and the ageing population it is important to develop an understanding of how ACPs are being utilised in care home settings and to explore how they improve access to primary care for residents.

Knowledge gained from this project will help to inform both policy and practice. It will provide valuable insight into the ACP scope of practice which will inform their training and support. Improving our understanding about stakeholder perspectives will inform decisions about the deployment of ACPs in care homes across England.

How will the project be delivered?

Experienced qualitative researchers will undertake semi-structured interviews with 15-20 ACPs who visit care homes. Questions will explore their role in providing primary care in these settings. Members of the Q community will be invited to contribute to developing a list of 15-20 key stakeholder roles. Stakeholder interviews will increase our understanding the wider impact of ACPs in care homes.

After gaining ethical approval from the University research ethics committee, ACPs who visit care homes as part of their clinical work will be recruited purposively to achieve diversity of location, and experience across England.  The recruitment strategy will involve posting an advert on an advanced clinical practice facebook group of almost 6000 members. For the stakeholder interviews ACPs will be asked to pass on invitation emails to their GP colleagues, care home managers, and relatives. Confidentiality and anonymity will be provided throughout the project.

What and how is your project going to share learning throughout?

It is important to understand how ACPs provide primary health care to care home residents and what their training and support needs are.

Study findings will be submitted as an abstract to present at the Health Services Research Conference in 2020, and will be submitted for publication in an academic journal.

The findings from the ACP interviews will inform commissioners about current models of care and inform educators and clinical managers about training needs of ACPs in this role.

The findings from stakeholder interviews will increase our understanding about the  primary healthcare needs of care home residents, and how ACPs can best meet those needs. Importantly we will explore what this role means for commissioners in terms of economic benefits.

How you can contribute

  • We would value any comments or suggestions from Q community members on further developing this idea.
  • In particular recommendations of key stakeholders who may have an interest in further understanding primary care provision by ACPs in care homes.
  • It would also be helpful for us to understand any current training provided for ACPs to provide this important service to care home residents.

Plan timeline

6 Jan 2020 Literature review and patient and public involvement (PPI)
3 Feb 2020 Design information sheet/consent form and apply for ethics
2 Mar 2020 Begin ACP recruitment via social media and start interviews
6 Apr 2020 Recruit stakeholders via organisations identified by ACPs
4 May 2020 Interview stakeholders and organise transcription
1 Jun 2020 Start analysis and discuss emerging findings with PPI group
6 Jul 2020 Complete data analysis and present at a conference
3 Aug 2020 Write up findings to illustrate scope and impact of ACPs
7 Sep 2020 Write academic paper to disseminate findings
5 Oct 2020 Present findings to PPI group

Comments

  1. This sounds really interesting Rachel, and a well thought out project. Great to see a project based in care homes!

    1. Dear Bethan, many thanks for your encouragement. I'm passionate about improving healthcare for vulnerable patient groups and see ACPs as important providers of primary care to residents of care homes. This project will improve our understanding of their impact and identify specialist training needs to improve care.

      I'd be grateful for any further advice on how this idea could be improved.

      Best wishes, Rachel

  2. Hi,

    This may not help but I have always wondered why ambulatory residents of care homes always receive their care as if they were housebound. Might there be an angle to your study that looks at the location of care delivered by ACPs?

    Tony

    1. Hi Tony,

      thank you for your comment; you make a very good point! I think your observation of the variation in location of care delivery are important. This is something we can explore through conversations with ACPs and other stakeholders.

      Many thanks

      Rachel

  3. I'd be really interested in the outputs from this and would be happy to share information through my networks.  In terms of stakeholder engagement you may want to contact the NHS England Ageing Well programme, which includes rollout of the Enhanced Health in Care Homes Framework as part of the NHS Long Term Plan.  I'd be happy to put you in touch if helpful.

    1. Dear Natalie,

      Thank you for your interest in this idea. I'm overwhelmed by the support from this group. I will add your very helpful suggestion of interviewing a member of the NHS England Ageing Well programme to my list of potential stakeholders, and if this proposal is successful I would be very grateful for an introduction.

      Many thanks

      Rachel

  4. Hello Rachel

    This is an excellent idea.We have a variety of models based on ANPs going into care homes here in Norfolk - very happy to share or get you into contact if that would be useful for you.

    1. Dear Kate,

      Many thanks you for connecting me with one of your ANPs in Norfolk, it sounds like she does amazing work for care home residents. Her advice has helped to refine the project and increased my motivation to further understand and share the work of ACPs in care homes across England.

    2. HI Rachel

      have sent you a private message re putting you in contact with some of our services

    3. Hi Kate, thank you for your encouragement. It would be fantastic to hear about the models you've encountered in practice. There is little evidence on how ANPs are utilised in care homes, so we're very excited about identifying their scope of practice and impact on primary care provision. It is particularly important to understand what they are doing in order to inform support in clinical decision-making.

  5. I think this is important work and would be interested to see how it links in with primary care networks moving forward. I trained In Australia with many nurses with extended roles and found they had a great approach and I think there are many wider roles for ANP or ACP and care homes are particularly important.

    1. Thank you for your comment Elizabeth. It's great to hear about the work of ANPs internationally. There is very little research on how this role is utilised in providing primary care to residential homes. Our study hopes to understand the scope of the role and the impact it has on wider stakeholders, such as GPs, commissioners, and care home managers.

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