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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)

  • 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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