Step 1 : Description
Step 2 : Feelings
Services ‘ Long-Term Plan ’ released in January 2019 ( Kings Fund , 2018 ). This has prompted a national commitment of increased funding into primary care services with a focus on the development of existing clinical workforces to ensure a more responsive primary care sector ( Kings Fund , 2018 ).
To be successful in its transition , it has been recognised that the healthcare environment requires the development of a clinical workforce that demonstrate effective leadership underpinned by the right fundamental values . Internationally , it has been agreed that leadership is an integral part of advanced practice ( Department of Health , 2010 ) placing Advanced Clinical Practitioner ’ s ( ACP ’ s ) in a prime position to lead change . What is not clear is the definition of leadership at an advanced level and guidance on how to apply it successfully within the healthcare environment .
This paper will provide a reflective account of the author ’ s role in developing a new service , focusing on how the author considered and applied leadership to their practice . To achieve this , the paper will explore contemporary leadership styles to determine which best encapsulates the essence of advanced practice . It will begin by introducing styles of leadership and critically evaluating their effectiveness in this context . To provide a reflective framework , Gibbs ‘ reflective cycle ’ ( Gibbs , 1988 ) has been used as it is a familiar model of reflection used within the health professions and allows a clear and precise use of stages to assist the author in making sense of experiences .
Step 1 : Description
To address the medical shortfall locally within primary care , the clinical commissioning group ( CCG ) proposed the development of a new service to act as an urgent care pathway with a view of managing patients presenting with acute illness . In response , the primary care trust ; in collaboration with secondary care and local ambulance services , introduced an ACP led service at the beginning of 2019 . The aim of this service was to provide advanced medical intervention within the home environment to support demand within general practice , add a new dimension to the traditional offering of community services and allow a more holistic approach to care delivery . The service would target patients who would otherwise present to emergency services such as ambulances and A & E departments , thus providing an alternative to hospital admission whilst meeting the national health agenda of providing acute care closer to home ( Department of Health , 2010 , Kings Fund , 2012b , NHS England , 2014 ).
Step 2 : Feelings
The author was concerned that the introduction of an ACP led service would be met with an element of resistance from both nursing and medical colleagues which could be perceived as a restraining force ( Lewin , 1951 ) and make the process of change more difficult . Hewison ( 2012 ) explored nurse manager ’ s accounts of change and forces working against . Key themes such as threats to the existing order of healthcare , workload saturation and fear of the unknown were identified .
Similar themes from a medical perspective had previously been shared by Wilson et al ( 2002 ); who suggested threats to the pre-existing order of healthcare and GP status , capabilities of nurses regarding responsibilities as well as structural and organisational factors were four main drivers fuelling GP concern , resulting in a reluctance amongst medical colleagues for the use of ACPs within primary care . It is important to note however , that the focus group study conducted by Wilson et al ( 2002 ) represented the views of only four GP practices based within Yorkshire . To enforce this argument , a broader perspective would need to be gained . It ' s also important to note that the study ( Wilson et al , 2002 ) is outdated , with more recent evidence suggesting that the substitution of doctors with nurses has the possibility to produce financial savings and reduce the burden of general practice workloads without compromising patient care or experience ( Biezen et al , 2016 ).
The author used this information when communicating with key stakeholders to gain acceptance and support of the service . It allowed