In several cases, consumers compared the confidence they had in their advanced practitioner to confidence in other providers. Answers varied from an absolute refusal to seek other support if their advanced practitioner was absent, to a feeling that medical practitioners, particularly locum doctors, did not build relationships:
When you go to the doctor, it’s not the same. You’re just in there and they want to hurry up and get rid of you… See, they don’t really care about me…I’m just a bloody number… We’re just dollar signs when we go to the doctors. (P6)
Participants described differences they perceived between their NP/PP and registered nurse or pharmacist, respectively. One consumer attributed this difference in confidence to a feeling that their NP operated with greater autonomy than a registered nurse:
I probably wouldn’t have… [taken my son for education] with either just a registered nurse or a doctor… whereas… he [my son] had that relationship with her [NP],… that was a role she would pick up and lead really well. I don’t know that I would have had necessarily the confidence in some of the registered nurses because… they’re not working autonomously in the same way. (P20)
Where consumers had unmanaged long-term conditions or needed close monitoring, they often then received PP services. These consumers explained changes in their usual feelings of exasperation because of their PP’s intervention:
It’s given me confidence in myself that if… things aren’t going right, I can turn to somebody who I think cares and knows what to do. Whereas I'll just plug in more insulin and get nowhere. (P1)
In turn, this feeling of confidence, both in self and in the provider, was framed around discussions that NPs/PPs operate in a more personalised manner than other practitioners.
Being known
Consumers spoke of the availability of NPs/PPs to deliver services in locations separate from general practice, for example, on marae (a Māori meeting/gathering place) or rural hubs. They considered advanced practitioners to have more time to spend managing health care needs and often noted shorter appointment wait times. Consumers described their advanced practitioner as part of their journey to good health, a return to personalised care, and openness to the whole person and their family, rather than a sick patient:
She's been part of my journey as well. She is so proactive, and you get that old-fashioned personal care again. She doesn’t start typing the script as you walk in. She doesn’t assume that because you're big you need a lecture on weight and then just toss whatever else is wrong with you… You get to have that faith and trust in her… I suppose she gets to know you. (P16)
The same phenomenon described the PP role:
Just because you have type 2 diabetes doesn’t mean that we all should be on two tablets… because everybody’s body is different, and that’s what she focuses on, that we’re all different… That’s what she’s taught me. (P4)
Consumers advised that their advanced practitioners understood their needs holistically. They saw this approach to care as patient-centred, accessible, and reflecting individual needs. This led them to feel confident that they, the consumer, owned the process and were actively involved in their own care.
Doctors tell, advanced practitioners discuss
Consumers commented that advanced practitioners worked to facilitate consumer understanding of the care they received. This understanding occurred because of (1) increased consultation time with NPs/PPs, (2) the language advanced practitioners used, and (3) delivering services in a way that consumers understood their treatment. Consumers recognised and trusted their advanced practitioner’s clinical skills, and felt their practitioner listened to them. The following narrative offers a comparison between GP and NP services:
He [the GP] knows his stuff… and that’s what I like about him… He’s just doing his job and that’s it. Whereas that’s what makes me comfortable with her [the NP], because she kind of is like well “how’s your day going”… So it’s a lot more personal. Yes, and that’s what I like. It’s explained in the language that we understand… She makes sure that you understand everything before you leave. (P11)
Consumers further emphasised the role of advanced practitioners in improving health literacy. They described a ‘holistic’ model of care that brought underlying health problems to the surface and facilitated use of other forms of health service delivery, such as rongoā (traditional Māori medicine):
If she goes to the marae, [Māori people] will come. They won’t come in here, into the doctor…. and we don’t go to him… They [PP] allow the Māori medicine side to also work… If they went to the doctor, he might say no, this is what you have to do… Where she will listen and work both sides. (P18)
Participants discussed being able to communicate with their advanced practitioners. PPs were often available via text message, phone call, or email. Consumers emphasised the stability or ‘constant’ that these providers and NPs offered their patients and how this influenced continuity of care:
So many GPs now you’ve gone to a practice and you can never get that constant ongoing care, whereas having… my nurse practitioner, it's like having that constant person that knows you every visit. It's that continuity of care. (P16)
Similarly, consumers broadly commented that doctors “tell”, and advanced practitioners “discuss”:
Doctors, they tell you things… But she [PP] can sit there just talking for 10 minutes, see how you are, how you’re feeling… I find her more important to me. I know more of what’s going on talking with her than with the doctor… He’s got an appointment every 10 minutes, so he’s got to shove you in, shove you through. (P1)
Provider passion
Participants described their NP/PP as passionate in their roles as health professionals. It was common for consumers to see their advanced practitioner as “magic” (P1) and fulfilling their roles as health providers because of a commitment and desire to help others. Many consumers saw their providers as “on a mission to do great things” (P21) for them. This led consumers to feel that services were financially worthwhile.
In many cases, consumers of NP/PP services emphasised that by having advanced practitioners working in practices and locations where the NP/PP and their whānau (family), had been based for years, they then fit the practice and grew alongside their patients:
This is her whānau, so she’s more than happy to be here… She’s got roots here, whānau… She fits perfectly into this place. (P6)
Recognition of NP/PP commitment improved consumer confidence in themselves and the provider.