Primary care has often been negatively represented in the media, potentially adding to the notion that this is not an interesting or attractive place to work. I would like to give an honest opinion from my own experience of working within the primary care sector as a nurse and an advanced clinical practitioner (ACP).
When I completed my nurse training 10 years ago the perception was that primary care was not an exciting place to work, so my peers avoided submitting applications for such posts on qualification. Words such as ‘boring’, ‘easy’ and ‘deskilled’ were associated with general practice nursing, and primary care was not seen as an interesting area. This could not be further from the truth. Any role within primary care is demanding and stressful at times, but also very rewarding.
I started my career as a newly qualified nurse in primary care with feelings of apprehension. I quickly came to realise these feelings were unfounded. All members of the team – in administration, reception, secretaries, healthcare assistants, nurses and doctors – were friendly, helpful and supportive. This role certainly did not deskill me but added to the skills I already held. I believe I would not have developed so many different skills if I had started my career elsewhere. It opened my eyes to the career opportunities available within this sector and this gave me the passion and drive to progress.
Primary care is a place where development is acknowledged and encouraged regardless of your clinical background. I was soon encouraged to enrol on the master's in advanced practice course, which continued to add to the bank of skills I had gained during my career as a practice nurse. Following the successful completion of the advanced practice MSc, I became an independent and autonomous practitioner. This is a demanding and at times a stressful role, but one which gives much joy and work satisfaction.
‘In primary care you learn the skills of assessment, examination, diagnosis, creating a management plan and prescribing, all while upholding the principle of shared decision-making with the patient and ensuring you give high-quality care’
As an ACP in primary care, you are exposed to a range of diverse patient groups and clinical presentations from babies, infants and children to frail elderly people. I have cared for patients with acute illnesses, chronic diseases, exacerbations of conditions, red-flag presentations, potential malignancy, sexual health problems and terminal illness. For palliative care patients, I ensured they were comfortable in their final days by liaising with other disciplines.
A range of different skills is needed to manage primary care patients. You are often the first health care contact and you are required to make challenging and complex decisions on a daily basis. In primary care you learn the skills of assessment, examination, diagnosis, creating a management plan and prescribing, all while upholding the principle of shared decision making with patients and ensuring you give high-quality care to each patient in a 10-to-15-minute appointment. You need to think on your feet, use what equipment you have, grab your stethoscope and rely on your clinical skills, support and experience to make the right decision for your patients.
My time working in primary care helped me realise this is an innovative and exciting place to work, where you can really make a difference to people's lives. It is a generalised role in which you seem to be a ‘jack of all trades’ but you can also develop special interests. I developed special interests in both respiratory disease and women's health. You get to know your patients, you help them, you visit their home and provide continuity of care. You feel sad when they die and their families thank you for the care you have given. You make a difference and often save lives. What could be better than that?
This is a time of exciting developments and career prospects for ACPs and I would urge you to consider joining a primary care team, regardless of your clinical background. I have worked with ACPs with backgrounds in mental health, physiotherapy, paramedicine and paediatrics, who have all made a significant contribution to the team. There really is room to fly with your career.
Primary care has opened the door for me to exciting and new opportunities and for that I will always be grateful. I always strive to encourage new or experienced health professionals to make the move. If you do, I assure you that you won't regret it. Without taking the plunge into primary care I wouldn't be where I am now, a university lecturer, with an exciting future ahead.
‘Boring’, ‘easy’ and ‘deskilled’ are certainly not words I would use about being an ACP in primary care. The words I would choose are ‘exciting’, ‘innovative’, ‘supportive’ and ‘meaningful’. Above all, you have the ability to truly make a difference, while delivering excellent compassionate care.