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CAMHS won't see you now

Trial admin assistants and paramedics to reduce GP workload, says landmark review

Exclusive A major review of GP workload has recommended pilots of a wider range of practice staff, including employing medical assistants to take on paperwork and paramedics to assess requests for home visits.

The Health Education England-commissioned review recommends that practices are encouraged to take on a wider variety of practice staff to take work off GPs.

As well as supporting the wider use of physician associates, practice pharmacists and advanced nurse practitioners, it says GPs spend 11% of their time on administrative tasks which, if taken on by dedicated administrators such as medical assistants, would be the equivalent of 1,400 more full-time GPs.

The report also recommends practices employing paramedics, stating: ‘The potential for paramedics to substitute for GPs in the assessment of urgent requests for home visits merits further evaluation’

The long-awaited report – The future of primary care: creating teams for tomorrow by the Primary Care Workforce Commission, and led by Professor Martin Roland, professor of health services research at the University of Cambridge - also recommends that a ‘significant proportion’ of GPs’ face-to face consultations should be longer, with GPs given time in the working day to discuss patient care with hospital consultants through email and electronic messaging.

The report was commissioned by HEE as part of its 10-point plan for the GP workforce, and was trailed by health secretary Jeremy Hunt in his ‘new deal’ speech.

It had originally been commissioned to look at how many GPs were needed to introduce the new models of care outlined in NHS England Five Year Forward View, but this was pre-empted by Mr Hunt’s pledge of 5,000 new GPs by 2020.

It confirms the need to achieve the Government’s target – which Mr Hunt has since said will be ‘flexible’ – and backs the recommendations of the 10 point GP workforce plan released earlier this year. But it shies away from making any further recommendations on the numbers of GPs needed.

One of the report’s most radical recommendations is for pilots of medical assistants in practices, doing HCA-equivalent clinical work and acting as a personal assistant to GPs, an idea promoted by the RCGP.

It says: ‘If administrative staff (such as medical assistants) took on half of this work, this would be the equivalent to 1,400 more full-time GPs in England. New approaches to the best use of administrative support roles need active piloting and evaluation.’

It also adds that the ‘discussion around access has focused too strongly on practice opening hours’, and recommends instead that ‘general practices should be organised so that a significant proportion of face-to-face consultations can be longer in order to enable patients to have time to fully explore their health problems, their options for care and how they can best manage their conditions’.

The release on Wednesday comes just days after Pulse revealed that as many of half the GP training places available this year are unfilled in some areas, despite Health Education England being tasked with increasing the number of medical graduates choosing GP training to 3,250 by 2016.

At the HEE board meeting on Wednesday, chief executive Professor Ian Cummings did note that, despite the difficulty in boosting GP training intakes, the number of net GPs was growing by 500-600 a year.

Professor Cummings said: ‘We do need to bear in mind that, although we are by no means yet producing the number of GPs that we want for the future, we do need to recognise that every year at the moment we are producing more GPs than are leaving or retiring.’

HEE will now discuss the report and its recommendations before responding in early autumn.

RCGP said the report ‘could prove to be a valuable lifeline to help rescue general practice from years of neglect and under-investment’.

But a spokesperson added: ‘We reiterate our call to the Government to urgently deliver the 5,000 extra GPs in England it pledged prior to the general election – and to consider extending this to 8,000 which, in our opinion, is a more realistic target for meeting the needs of our changing population.’

Picture credit: Dominic Alves

Readers' comments (27)

  • There are many unanswered questioned e.g.

    Will there be any increased funding?
    If there is extra funding will this go to individual practices or to GP Federations?

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  • Having been an NHS worker for over 30 years please stop! Look at the service properly instead of review and reaction from stats. Do you really engage with frontline staff as well as the opinion machine the gurus, experts and medlers of the NHS. I will not put our doctors under any more pressure than they currently are. The media coverage should have a part of educating everyone as a patient on reality of how we care not constantly what is wrong that needs addressing but there is so much that works that is excellent pioneering I am so angry to see how clinicians, nurses NHS staff of all ranks are being abused and bullied into doing more and more of nothing rather than taking time being abel to deliver quality care we will sadly implode and there will be nothing left there are lots to be said of tradition and modern ways of working in a good way not a battering you round the head constantly way.

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  • must be having a laugh ---- alongside havent met a doctor who doesnt want 7 day working

    reading discharge letters, reading outpatients letters, reading casualty letters, reading patient request letters, prescriptions, blood tests, out of hours contact information, enhanced services assessments, tick boxing qof etc etc and attending loclaity meeting and ccg meetings and appraisal and revalidation, cqc information
    trying to find replacement partner
    trying to find replacement practice nurse
    more locality meetings
    federation meetings
    emails
    new demands new diktats new deal
    i used to enjoy being a GP
    RETIREMENT

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  • you don't need reseach to say how to reduce gp's work load. very nice to stay self employed gp employ more staff like assistant and paramedics.why not nurse practitiones etc etc. who will pay there wages? who will pay for extending premises to have more people in small practices.

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  • Yes - if the NHS pays for them then they can come in. But you can't get paramedics to stay in the country let alone sit in a GP office people!

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  • "recommended practices EMPLOY a wider range of practice staff, including medical assistants to take on administrative work and paramedics to assess urgent home visits"

    Herein lies the problem....If practices are expected to EMPLOY them, this doesn't address the problems of GP risks if any other healthcare professionals are not able to step up the the skills and expectations required and mistakes are made as a result.

    Risks GPs are undertaking are one of the many significant reasons why many are shunning this profession. Too much workload, short consultation times, speedy decision making throughout the day with no breaks etc etc

    In Scotland the new contract negotiations are trying to deal with reducing GP risks. Staff will hopefully be employed by the Health Boards. The plan is for a physican-led primary healthcare team. GPs will ONLY have responsibility for the care they DIRECTLY provide.

    This is the only hope for me staying as a partner in General Practice north of the border.

    I am concerned the negotiations in England are not aiming to protect GPs from the additional risks of employing other healthcare professionals.

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  • I would have thought being responsible for care provided for by people you dont employ was more risky.

    We dont need assess urgent home visits anyway - time as we arent an emergency service - there are paramedics who worjk for the ambulance service that can do that!

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  • without funding, this is dead in the water. People have to remember as GP partner we pay for staff including their pensions and also redundancies when we have to close!

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  • GP IS NOT AN URGENT SERVICE!

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  • Gosh, how easy is it for people who takes no responsiblities at all to be telling us what we need to do.

    Exactly what punters do when they watch footy - you can talk the talk as much as you like but we know it will make nuff all changes to the starting lineup of your favourit team. Do you know why? Because you have no right or responsibility to that decision!

    Who is paying for these glorified pundits anyhow?

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  • General Practice is not an emergency visiting service. In an emergency paramedics are expected to visit patients and this is part of the commissioned 999 service. So...the solution to REDUCE GP workload is to INCREASE GP workload but making us also responsible for 999 calls? Am I missing something here? I presume we will therefore get a huge chunk of cash from 999 given to us then? No? I thought not........

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  • Think this talks a lot of sense. If its an "URGENT VISIT!" why not send a paramedic first line.
    If reducing our workload by 50% increases GPs by 1400 - great.
    I agree the argument has focused too much on opening hours, we need to ignore them, tackle workload, and focus on continuity of care, yes ideally with longer appointments for challenging patients.
    And better, faster communication between 1ry and 2ry care is essential - we have one cardiologist who saves scores of outpatient appointments with a quick email.

    Granted there's no mention in there about how to implement any of this but then we know the answer to that, we need to increase funding.

    Don't think we should be all so quick to turn our noses up at sensible suggestions to reduce workload and keep us as the specialists that we are rather than general dogsbody for all the nonsense and admin that's created by the health service.

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  • "If administrative staff (such as medical assistants) took on half of this work, this would be the equivalent to 1,400 more full-time GPs in England."

    Well perhaps.....and only if half the administrative tasks we undertake could be handled equally effectively and safely by A.N.Other and every minute of that time could then be re-directed to direct patient contact instead so we'd actually be working more intensely but for less money. Then again, if that did happen, one would need to factor in the loss of GPs due to earlier burn-out or having to reduce hours.

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  • So patient rings 999 --> urgent visit agreed --> call handler chappy rings paramedics (now based in surgery) ----> sees patient --> does obs/examination --> and then comes the problem. The uncertainty of the diagnosis, a call needs to be made as there are no quick fix tests available. Presumably this scheme is to cut A&E attendances. 1. Patient refuses treatment 2. Patient wants to speak to own Dr (Us) etc etc etc. Who takes responsibility? GP I presume

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  • what a study--- if gp sees 40 patients in a day but if we ask 20 of them to see some one else whom patients don't want to see then then gp work load will be reduced.
    is it a research???
    who pays for the cost of alternatives and how it affects small pracctices, and premises , that will be a
    research. can you please do that instead please.

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  • Instead of solving the retcruitment crisis, the suggestion is that we dilute the GP work force with assistants etc.
    A few years down the road it will be said we dont need so many GPs , no need to invest in GPs just Get GPs to manage anfd take over when things go wrong.

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  • And who will pay these new employees? Are GPs expected to employ staff out of their dwindling wages? And risk yet more hikes in indemnity fees to be responsible for them clinically? Which stupid gps will think this is a good idea?

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  • I work abroad now - anyway not here to brag. I don't do house visits and just regular GP clinics. It means I see about 40 patients per day and I'm home at 530.
    I honestly think it would be a good idea to get house visits farmed out to a different group.
    It works in both ways - patients are much more determined to make to it to the practice. They're fine with because it is how its done.

    The house visit doctors are fairly happy too, they can access a summary if needed and get well paid for this work.

    Continuity of care does lose out to an extent in some cases but there has to be some give somewhere.

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  • Having become increasingly overwhelmed with home visits and urgent requests my practice appointed a paramedic last year. It is the best appointment that we have ever made. We rarely undertake home visits. Its not a solution for all of our problems but it has certainly made a difference.

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  • I feel this report is very sensible. People always feel scared with new changes.
    Assistant is good idea: need to think, what paperwork they can do, who is responsible for their mistakes and how to do quality work.
    longer consultation time is fantastic idea: I feel patient satisfaction will be more, doctors will be under less pressure of making mistakes, if they gain extra time by seeing cough and cold that can be used for a complicated case.
    Paramedics for home visits : not sure, paramedics are trained to deal with cardiac arrest etc not for GP problems treating uti / urti/ lrti , instead practice nurse attending theses cases may be a good idea.

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  • Another nail in the rapidly being constructed coffin of primary care. When will the Government learn that dumbing down increases costs while diminishing quality in equal measure.

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  • Azeem Majeed

    The report does contain some interesting data - for example, the increasing proportion of patient taking 5 or more drugs; and the decline in GPs as a percentage of all doctors in England. However, although there may be scope for some of the work of GPs to be carried out by non-medical groups - such as pharmacists, nurses, physician assistants and healthcare assistants - the report is less clear on how these groups could be trained in sufficient numbers to make a significant impact on primary care workload. The report is also unclear on how these non-medical professionals would be funded and employed.

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  • The future of General practice...get paramedics, physician assistants, pharmacists, nurses to do all the work. This is a well planned move. Government knows that thye can get all the primary care work done by other staff. In the meantime partnerships will be finished. Salaries will come down and there will be few GPs working at low wages. Intelligent ones will make a move and go to abroad( while the sun is shining there). We are not going to get anyone from India/Pakistan this time because the word seems to have spread all over that the General Practice in UK is not worth applying for. I don't see things improving. Salaries throughout the world are improving...we seem to be the only country where doctor's are paid less and less every year but our workload is increasing. Time is not far when our salaries would be less then doctor's earning in third world countries.

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  • @ Anonymous | GP Partner | 22 July 2015 6:16pm

    "GP IS NOT AN URGENT SERVICE!"

    Amen brother

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  • home visit is are real problem in uk. i was talking to a nurse fron newzeland . she says her practice has done one visit in 34 years and it was not necessary. home visit must attract a fee of £50. who pays? that is a question.
    oph feel it is there right not to take any patients to surgery even when relatives take them for shopping or to watch foofball match.

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  • I am a paramedic and work in General Practice. I do all the house visits and moreover take responsibility for my work load. Yes of course I will speak with the patients named GP when required but if it is agreed that a medication needs starting or a dose changing for example I take responsibility for this in terms of subsequent blood tests, referral etc. I couldn't do my role without GP support nor am I pretending to be a doctor I have a set a skills that I have developed over the last twenty years that allows me to recognise sick people and be curious enough to get to the bottom or at least try of people's illness and frankly I couldn't face another twenty years of front line A&E.
    I feel and am told that I am a valuable part of the team but it is not for all paramedics of course and as mooted the skill is being comfortable with ambiguity, stratifying risk and being prepared to be wrong.

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  • "Professor Ian Cummings did note that, despite the difficulty in boosting GP training intakes, the number of net GPs was growing by 500-600 a year".

    How does he work this one out?

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