- Our Work
- The Reformer Blog
1 April 2016
General practice is changing. Increasing demand and seven-day opening saw the Government pledge to deliver 5,000 more GPs by 2020 – 4,000 of whom will be new recruits, and 1,000 retained. One year in, however, the Government is already off track: analysis by Pulse magazine this week revealed that the target is set to be missed by more than half. Disappointing recruitment over the past four years, alongside high rates of retirement have led many, including the Public Accounts Committee, to speak of a “looming crisis” in GP workforce.
This diagnosis is premature. As the PAC report noted, a more sustainable approach to the GP workforce would look beyond expanding GP numbers “to develop the wider general practice workforce”. This could meet increasing demand within a seven-day service.
With no centrally collected figures on how appointments are administered, precisely how a reformed workforce might look is hazy – but estimates can be made. Recent research, based on interviews with GP staff, concluded that 27 per cent of appointments could be undertaken by another professional. This is likely to be a conservative figure: respondents’ estimates varied from 0 per cent to 73 per cent, depending on their understanding of the range of alternatives.
Estimates of GP appointment types reveal where care might be delivered by other professionals. Many appointments overlap – but the below chart provides an insight into how general practice might employ a more diverse workforce.
For musculoskeletal problems, the Chartered Society of Physiotherapy has argued that over 100 million appointments could be freed up each year through patient self-referral. Such appointments would, it is argued, cut costs by £33 per patient on top of unquantified savings through fewer appointments, such as scans and x-rays. It also can cut waiting times and improve patient satisfaction.
For other common conditions or medicines-related problems, pharmacists and practice nurses could offer care. Evidence from abroad shows that nurse-led primary care can have a positive effect on patient satisfaction, hospital admission and mortality. The Royal College of General Practitioners has labelled pharmacists the “hidden army” of the NHS, capable of meeting increasing demand, improving patient safety and care, while reducing waiting times for GP appointments.
Employing 5,000 more GPs is therefore not the most efficient way to meet increasing demand.
Harnessing the power of a range of clinicians will require a clear understanding of how appointments are currently conducted, and how clinicians might be trained to take on new roles. Larger practices, as shown by international leaders such as Southcentral in Alaska, which has redesigned its workforce to more efficiently address the needs of its 60,000 patients, will also be better placed to reshape their workforces. The implications and practicalities of these changes for the NHS will be outlined in a forthcoming Reform report on the future of general practice.