Great job on the Assembly! The songs were great and I learned some new facts about the Jacobites!

Dr Alastair Clubb, Chair, Access and delivery Working Group (and GP Lead, Primary Care Strategy) adds: I would like to highlight the general supporting evidence around the ANP role in primary care. The role of the Advanced Practitioner is complementary to the care offered by medical practitioners well as acting as primary care providers in their own right. Their expertise lies firmly in their ability to operate as ‘generalists’, providing complete episodes of care across any age range and across a wide variety of health needs and presenting problems. We help fill some gaps in healthcare shortages; being able to deal with a variety of acute presentations and same day and chronic long term condition appointments in particular means the role can alleviate some of the issues experienced by patients in terms of access and help fill the gaps resulting in the issues with recruitment and retention of GPs. This also enables GPs to see patients with more complex health needs, this is especially important given the new GP contract seeing the GP as very much the ‘expert medical generalist’. There is growing evidence to support that ANPs are able to provide safe and effective care. Systematic reviews as far back as 2002 found patients preferred to see a nurse in a nurse led clinic with few requiring referral to a GP. More recent systematic reviews appraising both the effectiveness and safety of the ANP showed the role to be positively evaluated across areas of patient satisfaction, clinical outcomes, and costs. ANPs in primary care settings were found to perform equally as well as physicians in terms of clinical outcomes and patient satisfaction and that whilst consultations might take slightly longer and result in more diagnostic tests and return consultations this did not result in overall increased costs. Additional evidence suggested patients seeing ANPs required fewer total primary care visits and that ANPs provided more thorough patient education - which one could suggest helps reduce the number of return visits and offers. I have no doubt that we could easily review NP/ANP prescribing, referrals rates and patient satisfaction in CWIC and find that are as good as if not better in terms of formulary adherence and referral rates that our medical colleagues. We have a few ANP/NP working in EL - I'm sure we would be delighted to look at current satisfaction and effectiveness at a local level should this seek to provide evidence to doctors unsure of our place and value in practice.