GP-led health centres 'dominated by nurses and salaried doctors'

04 Feb 09

Workforce projections from around a third of the centres awarded to date show some will have more than three nurses for every GP.

GPs in the new centres will almost all be salaried, with some expecting as many as 80% of those applying to be newly qualified or in their final year as registrars.

The average staffing ratio at the centres - which will offer list-based and walk-in appointments – is 1.2 nurses to every GP.

But that figure masks stark variations between models, with three planning to employ more GPs than nurses, but others having many more nurses than GPs.

Our investigation collected detailed information on plans for staff and services at 17 of the centres – hailed by health secretary Alan Johnson as the blueprint for the future of general practice – from roughly 50 contracts awarded to date.

It found:

• One centre where there will be 10 practices nurses but just three GPs

• Two providers that admitted they would be staffed mainly by new GPs, with one admitting they made up 80% of applicants

• A PCT that refused to grant contracts to two providers that were successful elsewhere, because of concerns about over-reliance on locums

• Just three centres planned to offer partnerships.

Dr Richard Pannett, a GP in Norwich, and director of Norwich Practices Ltd said his consortium of local GPs would run a ‘nurse-led service’, split 10 to three in favour of nurses and focused heavily on walk-in patients.

‘There is much more emphasis on nurse-triaging,’ he said.

Dr Mark Hunt, managing director of private firm Care UK, which has so-far won contracts for four GP-led health centres, said list-based appointments would be split 50/50 between GPs and nurses, but walk-in appointments would be done 90% by nurses and 10% by GPs.

He said: ‘Our model is nurse-led for walk-in-centres. For the general practice side, the acute and chronic disease side is largely dealt with by nurses – and more complex co-morbidity by GPs.’

Dr Hunt insisted salaried doctors would offer the same level of continuity of care as partners who only worked part-time.

GPC Negotiator Dr Chaand Nagpaul said the findings contradicted the term ‘GP-led’.

He said: ‘This confirms that the skill mix is considerably at variance to the normal style that patients have repeatedly affirmed their approval of. If you have centres that have more nurses than GPs, the term GP-led health centre is questionable.

‘We worry that the continuity of care provided by GPs is at risk.’