No more GPs? No problem

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.

AHit blog GP table

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.

Comments

Comments

We May Not Need the 5000 GPs That We Think We Need | HEALTHTECH.VC

30 April, 2016

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Daniel Stringer

17 April, 2016

Just wondering, how many of your "average" grass-roots GPs were consulted during your research? What is your own experience of primary care consultations? Consultations are actually pretty complex. Patients do not often present with the solution. In fact, patients may not present with the problem. It takes someone with a breadth of knowledge and good communication skills to tease out of patients what they need, and then plan the most efficient treatment. It's easy in retrospect to say they could have seen someone else. Your ideas are simplistic and threaten greater fragmentation, dissatisfaction, and duplication of services. I feel sorry for the GPs who will be left carrying the responsibility for non-doctor consultations of the patients they are increasingly distanced from. I feel sorry for the frustrated patients who don't get to access a clinician who can address a complex problem - and they are all complex, we're people not symptoms. Please talk to some actual primary care clinicians about this. The history of the NHS is littered with money being poured down the drain over bright spark ideas and reform.

Greg Wood

01 April, 2016

A fine idea in principle. It also works in practice: we already have health visitors, community psychiatric nurses, practice nurses and midwives, and pharmacists can provide medicines to patients. In the 1990s, the Major government thought it could use nurses in place of GPs. The problem was, about three nurses were needed to replace one doctor. A similar thing happened in 2004 when the Blair administration took away GPs' out-of-hours role: it suddenly became apparent how much efficient work the GPs had been doing, for little money or thanks. Whatever the job title, you need someone at the centre with a pretty high level of knowledge and experience, who can work quickly when necessary, and who has the confidence to make judgements without always asking for 'top cover'.