The Advanced Practitioner in Primary Care

Equipping Advanced Practitioners with the skills, insight, and confidence to lead in modern primary care

The Advanced Practitioner in Primary Care is a timely resource that provides current and aspiring Advanced Practitioners (APs) with a practical roadmap for delivering high-quality, patient-centred care in complex and fast-paced primary care environments. Built on the four pillars of advanced practice—clinical practice, leadership, education, and research—this text supports practitioners in bridging the gap between academic theory and clinical application.

Written by experienced clinicians and educators, this book is framed by national and international guidelines—applicable to adult, paediatric, and mental health contexts—and reinforced by real-world case studies that contextualise concepts and build confidence in managing diverse clinical scenarios.

Providing the structured support and evidence-informed guidance necessary for confident, competent, and reflective practice, The Advanced Practitioner in Primary Care:

• Covers complex consultation skills, clinical reasoning, systems-based clinical assessments, and decision-making with evidence-informed guidance
• Addresses the management of uncertainty and diverse patient presentations, including frailty and paediatrics
• Offers practical insights on getting the most from supervision and professional development pathways
• Includes a dedicated chapter on prescribing and medication management tailored for APs
• Discusses the evolving scope of the AP role in the context of local, national, and international policy

The Advanced Practitioner in Primary Care is essential reading for trainee and established APs working in primary care, as well as for nurses, paramedics, pharmacists, physiotherapists, and other professionals transitioning into general practice. It is also ideal for postgraduate programmes in advanced clinical practice and a valuable resource for educators and primary care teams supporting AP development.

Unit 1 – The ACP Role in Primary Care

Chapter 1 Scope of Practice and the ACP role in primary care

Josey Coaten

Aim

Learning outcomes

Introduction

Chapter 2 How to get the most from supervision in practice

Sarah Pay

Aim

Learning Outcomes

Introduction

What is supervision?

Competence and Capability

Frameworks and Standards

Tailored Supervision

Planning Supervision in Primary care

Overcoming barriers to supervision

Demonstrating capability

Self- Awareness

Reflective Points

References

Chapter 3 Patient Centred Care

Josey Coaten

Aim

Learning outcomes

Introduction

Chapter 4 Clinical Uncertainty

Sarah Pay

Aim

Learning Outcomes

Introduction

Types of Uncertainty

Managing uncertainty

Information gathering

The value of time as a tool

Safety Netting

Ethical Considerations and shared decision making

Back to Basics

Communicating uncertainty

Uncertainty and Burnout

Reflective point

References

Unit 2 – Leadership

Chapter 5 Leadership

Josey Coaten

Aims

Learning outcomes

Introduction

Chapter 6 Research Pillar in Primary Care

Sarah Pay

Aims

Learning Outcomes

Introduction

The importance of the research pillar for ACPs

Challenges of embedding research into primary care ACP roles

Evidence Based Practice

Research Opportunities and the National Institute for Health can Care Research (NIHR)

Clinical Academic Roles

Quality Improvement

Audit

Reflective Points

References

Chapter 7 Education and Teaching

Josey Coaten

Aims

Learning Outcomes

Introduction

Unit 3 – Consultation skills

Chapter 8 Consultation Models

Sarah Pay

Aims

Learning Outcomes

Introduction

Consultation Models Introduction

Overview of Models

Using a model in practice

The short or 15 minute consultation and agenda setting

Remote Consultations

Conclusion

Reflective points

References

Chapter 9 Advanced Clinical Reasoning

Josey Coaten

Aims

Learning Outcomes

Introduction

Unit 4 – Clinical Examination and Assessment

Chapter 10 History Taking

Sarah Pay

Aims

Learning outcomes

Introduction

Applying Structure to history taking

Care study

Preparation (Housekeeping)

Introduction and Rapport Building

Presenting Complaint

Ideas, Concerns and expectations

History of Presenting complaint

Past Medical History

Vaccination History

Medication History

Allergies

Family History

Social History

Occupation

Travel

Sexual history

Systematic enquiry

Closing the encounter

Difficult Consultations

Collateral History Taking

Communication considerations in history taking

Managing time

Digital tools in history taking

Care study reflection

References

Chapter 11 Introduction to clinical examination in primary care

Sarah Pay

Aims

Learning Outcomes

Introduction

Equipment

Home Visits

The acutely unwell patient

Red Flags

Chaperone

Structured examination principles

Preparation/Housekeeping

Environment

End of bed/chair

Inspection

Hands

Face and Mouth

Palpation

Percussion

Auscultation

Lymph Node Assessment

History considerations

Inspection

Palpation

Red flag signs for lymphadenopathy

Typical features of lymph nodes and associated pathology

Decision making, referrals or admissions

Case Study – Lymphadenopathy

Closer Look- Lymphoma

References

Chapter 12 The Respiratory System

Sarah Pay

Aims

Learning Outcomes

Introduction

History taking for the respiratory presentation

Preparation

Initiating the consultation

Taking a respiratory history

Common Presenting Symptoms

Chest pain

Cough

Sputum

Breathlessness

Wheeze

Stridor

Haemoptysis

Fever/Night sweats and Rigors

Weight Changes

Sleepiness

Red Flags

Clinical Examination of the respiratory system

Environment

End of the bed assessment

Hands and arms

Face, eyes and mouth

Neck

Inspection

Palpation

Percussion

Auscultation

Posterior

Legs

Common Presenting complaints in primary care

Other investigations in primary care

Pulse Oximetry

Sputum Cultures

Spirometry

ECG

Peak Flow

Fractional exhaled nitric oxide

Chest X-ray

Blood tests

Rapid point of care testing for C-Reactive Protein

Pertussis testing

Risk tools

Case Study – Community Acquired Pneumonia

References

Chapter 13 The Cardiovascular System

Josey Coaten

Aims

Learning outcomes

Introduction

Chapter 14 Abdomen/Urology and Gynaecology

Josey Coaten

Aims

Learning outcomes

Introduction

Chapter 15 Neurological Assessment

Josey Coaten

Aims

Learning Outcomes

Introduction

Chapter 16 Musculoskeletal and Rheumatology

Sarah Pay

Aims

Learning Outcomes

Introduction

Chapter 17 Ear, Nose and Throat

Josey Coaten

Aims

Learning Outcomes

Introduction

Chapter 18 Dermatology

Sarah Pay

Aims

Learning Outcomes

Introduction

Taking a dermatological history

Common presenting symptoms

Itching

Rash

Lesions

Pain

Psychosocial factors

Examination of skin

Inspection

Description

Palpation

Systematic Review

Examination of moles

Dermoscopy and photography

Red flags

Case study

References

Chapter 19 Paediatrics in Primary care

Sarah Pay

Aims

Learning Outcomes

Introduction

Initiating the consultation with a child and history taking

First Impressions

Introductions and Rapport building

Golden minute and establishing ICE

Taking a history

Examination

Airway

Breathing

Compromised respiratory system

Respiratory distress

Respiratory Rate

Oxygen saturation

Chest Auscultation

Circulation

Colour

Heart Rate

Capillary Refill time

Blood Pressure

Disability

ENT Examination

Temperature

Tummy

Blood Glucose

Examination Tips

Identifying serious illness in children

Vital signs

Traffic light system/PEWS/Sepsis

The Febrile Child

Management and parental/carer advice

The unexplained fever

Growth and Feeding

Safety netting

Professional and Legal Issues in Paediatrics

Consent

Gillick Competence

Fraser Guidelines

Safeguarding

Prescribing for children

Closer look – Kawasaki Disease

Case Study – Bronchiolitis

Common differential in primary care – feverish illness

Useful resources

References

Chapter 20 Mental Health in Primary Care

Sarah Pay

Aims

Learning Outcomes

Introduction

History taking in Mental Health consultations

Mental Status Examination (MSE)

Determining risk

Ethnicity

Frailty

Maternal Mental Health

Learning Disability

Gender

History taking framework for mental health

Legislation and mental health

The Mental Health Act 1983

The Mental Capacity Act 2005

Management of common low risk presentations in primary care

Social Prescribing

Generalised anxiety disorders

Depression

Bi-Polar Disorder

Mental health of the practitioner

Useful information

Case study – depression

References

Chapter 21 Frailty

Josey Coaten

Aims

Learning outcomes

Introduction

Chapter 22 The advanced Practitioner as a Prescriber

Sarah Pay

Aims

Learning Outcomes

Introduction

NMP Professional Considerations

The NMP and Scope of practice in primary care

Continuing professional development as a prescriber

Remote Prescribing

Repeat Prescribing

Medication Reviews

Re-authorisation of repeat medications

Medication Review

Structured Medication Review (SMR)

Medicine Reconciliation

Polypharmacy

Medicines Optimisation

Medicined optimisation for older people

Antimicrobial stewardship

Delayed prescriptions

Communication regarding antibiotic prescribing

Supporting other NMP’s

Reflection Activity

References

Chapter 23 Completing the consultation/developing as an ACP and beyond

Josey Coaten

Aims

Learning Outcomes

Introduction

Josey Coaten is a lecturer and Programme Director for the MSc Advanced Clinical Practice at the University of Hull. An experienced registered nurse and Advanced Clinical Practitioner, she is also a non-medical independent prescriber. Josey brings extensive experience from primary care, having held roles from practice nurse to Senior ACP. She holds a postgraduate certificate in academic practice and is a Fellow of AdvancedHE.

Sarah Pay has experience as a lecturer in the MSc Advanced Clinical Practice programme at the University of Hull and currently works as an ACP and clinical educator at Haxby Group. With a background in adult nursing, she has worked extensively in primary care as both a practice nurse and a Senior ACP. She is a non-medical prescriber and holds a postgraduate certificate in academic practice, as well as being a Fellow of AdvancedHE.