Traditionally nurses with master’s degree in advanced practice (known as advanced nurse practitioners or ANPs) in primary care, have worked either in enhanced roles, as substitutes for doctors (or a mixture of both) and continue to be registered with their base profession in the absence of a nationally regulated competence framework.^9,11

The literature suggests that appropriately qualified ANPs deliver similar levels of care as doctors and are acceptable to patients. However, use of ANPs may not relieve GP workload or reduce service utilisation or costs, at least in the short term⁹ and information about the role’s integration in general practice is currently lacking.

Well-established role in US but relatively new to UK with numbers growing.¹¹

Defined as ‘a new healthcare professional who … works to the medical model, with the attitudes, skills, and knowledge base to deliver holistic care and treatment within the general medical and/or general practice team under defined levels of supervision.’¹³

Most have a basic science degree before undergoing 2-year training programme.

Cannot independently prescribe/order X-rays and must carry out defined duties under supervision to support doctors, working in a variety of ways to provide care in general practice, with general aim of seeing patients with acute minor illness for same-day or urgent appointments.¹⁴

Working in general practices for over a decade providing a variety of medicine-management related functions,²¹ initially in non-patient-facing roles but more recently with a greater focus on medicines optimisation and patient-centred care.²²

Regulated to allow prescribing rights.

Role increased in scale as a result of national initiatives such as NHS England’s Clinical Pharmacists in General Practice programme, which has committed £100 million to fund 1500 clinical pharmacists by 2020–2021²³ and recent enthusiastic support for the role in general practice in some quarters. ^24–26

No peer-reviewed research could be found on the multiprofessional AP role in general practice incorporating non-nursing clinicians.

The combined professional bodies and Royal Colleges representing the health workforce have recently published a multiprofessional framework for advanced clinical practice in England to be implemented by 2020;¹² advanced training is usually over a period of 2 years.

There is currently variation in prescribing rights among APs from different professional backgrounds; that is, nurses have the right to become IP qualified; a very recent Human Medicines Regulation amendment allowed paramedics eligibility; physiotherapists have limited prescribing rights.

Limited evidence suggests PAs may provide safe and effective care that is acceptable to patients but may also generate activity in terms of return visits, tests, or prescriptions ordered, and referrals therefore increasing service utilisation/costs.⁹

PAs cannot yet practice autonomously¹⁵ however, following a consultation period, in early 2019 the Department of Health and Social Care stated an intention to introduce statutory regulation for PAs.¹⁶

Often promoted as beneficial to general practice,¹⁷ but lack of current regulation is a barrier to integration here.^18–20

Training to become a pharmacist involves a 4-year master’s degree of pharmacy plus 1-year pre-registration experience in employment. No further qualification is required to work as a general practice pharmacist, although those in the role usually have (or are encouraged to complete) a postgraduate diploma in clinical pharmacy and the IP qualification.

Role may aim to substitute for GPs or nurses on some tasks, and/or supplement the work of these professionals.

Limited evidence suggests pharmacists in general practice can improve both chronic disease management for some long-term conditions and quality of prescribing, and may be acceptable to patients,^27–29 but may not reduce service utilisation or costs.^9,30