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GPs go forth

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
    new demands new diktats new deal
    i used to enjoy being a GP

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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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  • 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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