Advanced Practitioners are an integral part of the 21st century NHS workforce as new models of care are transforming the way patients are treated. Advanced Practitioners work at level 7 across the four pillars of advanced practice – clinical, management & leadership, research & education, and offer multiple benefits to the health service and the population.

They bring more holistic care to patients, support continuity of care and extend the scope of practice across traditional boundaries. This leads in turn to a greater focus on prevention, more personalised care, a more efficient team, a faster response to patient needs and better outcomes.

They are instrumental in supervising the multi-professional team in primary care, they attract and lead research and audits, and manage highly complex high-risk patients. They have a leadership role in the ICS around pathways and population health.

https://www.hee.nhs.uk/our-work/advanced-clinical-practice

Care Coordinators play an important role within a PCN to proactively identify and work with people, including the frail/elderly and those with long-term conditions, to provide coordination and navigation of care and support across health and care services.

Care Coordinators could potentially provide extra time, capacity, and expertise to support patients in preparing for or in following-up clinical conversations they have with primary care professionals.

They will work closely with the GPs and other primary care professionals within the PCN to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers, and ensuring that their changing needs are addressed. This is achieved by bringing together all the information about a person’s identified care and support needs and exploring options to meet these within single personalised care and support plan, based on what matters to the person.

https://www.e-lfh.org.uk/programmes/person-centred-approaches/

Clinical pharmacists work in primary care as part of a multidisciplinary team in a patient-facing role to clinically assess and treat patients using expert knowledge of medicines for specific disease areas.

They will be prescribers, or if not, can complete an independent prescribing qualification following completion of the 18-month Centre for Pharmacy Postgraduate Education (CPPE) pathway.

They work with and alongside the general practice team, taking responsibility for patients with chronic diseases and undertaking clinical medication reviews to proactively manage people with complex polypharmacy, especially for the elderly, people in care homes and those with multiple comorbidities.

Dietitians are healthcare professionals that diagnose and treat diet and nutritional problems, both at an individual patient and wider public health level.

Working in a variety of settings with patients of all ages, dietitians support changes to food intake to address diabetes, food allergies, coeliac disease and metabolic diseases.

Dietitians also translate public health and scientific research on food, health and disease into practical guidance to enable people to make appropriate lifestyle and food choices.

First Contact Physiotherapists (FCPs) are qualified autonomous clinical practitioners who can assess, diagnose, treat and manage musculoskeletal (MSK) problems and undifferentiated conditions and – where appropriate – discharge a person without a medical referral.

FCPs working in this role can be accessed directly by self-referral or by staff in GP practices who can direct patients to them to establish a rapid and accurate diagnosis and management plan to streamline pathways of care.

https://www.csp.org.uk/professional-clinical/first-contact-physiotherapy

As part of the wider team in general practice, General Practice Assistants provide a support role, carrying out administrative tasks, combined in some areas with basic clinical duties.

They focus on supporting General Practitioners in their day-to-day management of patients, specifically aimed at reducing the administrative burden, making the best use of consultation time and supporting those particularly vulnerable to isolation who are regular attenders at the practice.

Development of the role depends on a range of factors – patient needs, existing skills mix, culture and having the staff, time and financial resources to invest in work-based learning, mentorship and supervision.

https://www.hee.nhs.uk/our-work/gp-assistant 

Health and Wellbeing Coaches (HWBCs) will predominately use health coaching skills to support people with lower levels of patient activation to develop the knowledge, skills, and confidence to become active participants in their care so that they can reach their self-identified health and wellbeing goals. They may also provide access to self-management education, peer support and social prescribing.

HWBCs will use a non-judgemental approach that supports the person to self-identify existing issues and encourages proactive prevention of new and existing illnesses. This approach is based on using strong communication and negotiation skills, supports personal choice and positive risk-taking, addresses potential consequences, and ensures people understand the accountability of their own decisions based on what matters to the person.

They will work alongside people to coach and motivate them through multiple sessions, supporting them to self-identify their needs, set goals, and help them to implement their personalised health and care plan.

https://www.england.nhs.uk/publication/health-coaching-summary-guide-and-technical-annexes/

Mental Health Practitioners – including Improving Access to Psychological Therapy (IAPT) – to be included in the scheme from April 2021 – Awaiting further advice and guidance.

Working alongside GPs to meet patients' healthcare needs.

The Nursing Associate is a new support role in England that bridges the gap between healthcare support workers and registered nurses to deliver hands-on, person-centred care as part of the nursing team. Nursing Associates work with people of all ages in a variety of settings in health and social care.

The role was introduced in response to the Shape of Caring Review (2015), to help build the capacity of the nursing workforce and the delivery of high-quality care.

It will be a vital part of the wider health and care team and aims to:

• support the career progression of healthcare assistants

• enable nurses to focus on more complex clinical work

• increase the supply of nurses by providing a progression route into graduate-level nursing.

For further information about the Nursing Associate role visit

Working alongside GPs to meet patients' healthcare needs.

Occupational therapists (OTs) support people of all ages with problems resulting from physical, mental, social, or development difficulties.

OTs provide interventions that help people find ways to continue with everyday activities that are important to them. This could involve learning new ways to do things or making changes to their environment to make things easier. As patients’ needs are so varied, OTs help GPs to support patients who are frail, with complex needs, live with chronic physical or mental health conditions, manage anxiety or depression, require advice to return or remain in work and need rehabilitation so they can continue with previous occupations (activities of daily living).

Working alongside GPs to meet patients' healthcare needs.

This role is currently under review.

A qualified HCPC registered Paramedic has at least 3 years of postgraduate experience.

There needs to be a narrative that highlights their paramedic skills around trauma, emergency and urgent care and their ability to improve conveyance rates.

Working alongside GPs to meet patients' healthcare needs.

Pharmacy Technicians play an important role within General Practice and complement the work of Clinical Pharmacists through the utilisation of their technical skillset.

Their deployment within primary care settings allows the application of their acquired pharmaceutical knowledge in tasks such as audits, discharge management, prescription issuing, and where appropriate, informing patients and other members of the PCN workforce.

Work is often under the direction of Clinical Pharmacists, and this benefit is realised through the creation of a PCN pharmacy team.

Working alongside GPs to meet patients' healthcare needs.

Physician Associates (PAs) are healthcare professionals with a generalist medical education who work alongside doctors providing medical care as an integral part of the multidisciplinary team.

Physician Associates are dependent practitioners who work under the supervision of a fully trained and experienced doctor. They bring new talent and add to the skill mix within teams, providing a stable, generalist section of the workforce which can help ease the workforce pressures that the NHS currently faces.

Working alongside GPs to meet patients' healthcare needs.

Podiatrists are healthcare professionals who have been trained to diagnose and treat foot and lower limb conditions.

Podiatrists provide assessment, evaluation and foot care for a wide range of patients, which range from low risk to long-term acute conditions.

Many patients fall into high-risk categories such as those with diabetes, rheumatism, cerebral palsy, peripheral arterial disease and peripheral nerve damage.

Working alongside GPs to meet patients' healthcare needs.

Social prescribing enables all primary care staff and local agencies to refer people to a link worker.

Link workers give people time and focus on what matters to the person as identified through shared decision-making or personalised care and support planning. They connect people to community groups and agencies for practical and emotional support. They work within multidisciplinary teams and collaborate with local partners to support community groups to be accessible and sustainable and help people start new groups.

Social prescribing complements other approaches such as ‘active signposting’. Link workers typically support people on average over 6-12 contacts (including phone calls, meetings and home visits) with a typical caseload of 200-250 people per year, depending on the complexity of people’s needs and the maturity of the social prescribing scheme.