My colleagues reject me as a "half-doc" but my role mitigates the under-strength of the NHS | Society

I walk in the corridors of most British hospitals nowadays as an unknown entity. I go unnoticed when I mingle with herds of first and second degree doctors during a tour of services. I can not distinguish because of my clinical camouflage of a stethoscope, a pen-lamp and a pen (probably stolen). I am neither a doctor nor a nurse; not a physiotherapist, an operating department practitioner or an ambulance attendant. Yet my role can be all these things at once. I am an Advanced Clinical Practitioner (ACP) and the role has been presented as an innovative solution to a long-standing problem: chronic understaffing in health care.

ACPs are experienced health professionals licensed by the state (nurses, physiotherapists, paramedics, pharmacists, for example). We follow a period of clinical and academic training during which we tend to alternate specialties, such as law doctors, accumulating skills and knowledge along the way. This allows us to work at a level corresponding to that of our fellow mid-level doctors.

I became ACP because, in my previous role, there was virtually no recognized clinical progression or any potential for broadening horizons. The possibilities offered by advanced practice mean, however, that I have had the opportunity to learn from experienced academics and medical colleagues. I have also developed a set of skills ranging from taking blood, emptying the abdomen, communicating bad news and managing the emergency medical team. My clinical field was open in front of me and I really enjoyed exploring it.

The introduction of this role has met with mixed reactions. When I was first appointed as an ACP trainee, one of my colleagues said in a scathing tone: "Congratulations, you're going to be an F1 [a very junior doctor] for the rest of your life. Although I admire the apparent spirit of the comment, I am struck by the fact that my role is far from being universally respected and well understood. The following years, called "noctaires" (not a doctor) and "demi-doc", proved this point.

There are those who consider us as having abandoned our caring roots for the glamor of the medical team. There is no glamor to be so busy that neither a dangerously full bladder nor a hungry hunger are grounds for stopping and resting. Some view us as painting a catastrophic crack in an underfunded medical system, ignored and abused for decades.

We are not here to replace the doctors. It is generally accepted that being a middle-level doctor is one of the most difficult jobs in a hospital. they must also develop a portfolio of learning and research. ACPs can help support the clinical burden by allowing our fellow physicians to spend time with their consultant, audit, study and even relax. Overall, the idea is excellent and we have an openly positive impact on the working conditions of primary and secondary care physicians.

Consultants and managers who understand this role see us as an essential foundation for the delivery of high quality care. Our pre-existing clinical maturity and newly developed skills help us to integrate well in most departments, and patients respond very positively. They see us as reliable and accessible clinicians, concerned about their medical and non-medical well-being.

However, not everything is positive. Legislation related to archaic health practices and obtuse local policies frustrated the ACPs along the way. All changes are terribly slow to happen and, for no obvious reason, tend to be half measures. This only serves to confuse colleagues, managers and patients.

Idiosyncrasies such as being able to request an abdominal CT scan that is plentiful in radiation, but not being allowed to ask for a soft tissue ultrasound are commonplace. ACP countries can not sign "good for nothing" either, which hampers the progression of highly qualified clinicians and is an additional barrier to patients leaving the hospital.

Legal challenges such as what we can and can not prescribe also weigh on the ACP. On many occasions, I managed a patient with happiness and independence throughout his hospital trip, but I needed a doctor to write the last prescription. An ACP nurse doing exactly the same job as I do, however, has the right to prescribe the drug.

It is hardly surprising that fellow managers and medical staff consider these strange inconsistencies as flaws in the role. The truth is that we are just as frustrated by these factors. It is planned to better regulate advanced practice for all professions, regardless of their clinical context. Until then, I think we will continue to train ACP countries only to lose them because of inconsistent and poorly implemented working conditions.

Not only will it be a waste of time for everyone, but it will slow down the evolution of health care over the next few decades. That's why I encourage all health professionals and patients to unite for the development of ACP countries. We are determined to help in difficult working conditions, but we can only do so with the support of our colleagues and managers.

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