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Filling practices with non-doctors will not solve workforce crisis, say GPs

GPs do not believe that filling practices with non-doctors is going to solve the GP workforce crisis, according to a poll of delegates at the Pulse Live conference in London today.

GPs attending the Big Debate heard arguments for and against the suggestion that employing more non-doctors, such as physician associates, paramedics and practice pharmacists, would solve the workforce crisis.

The show of hands showed an estimated 40% of delegates agreeing that the measures would have little impact, while only 15% thought they would. A number of delegates remained uncertain.

Arguing this was not the solution, Dr Shaba Nabi, a GP trainer in Bristol, argued that replacing ‘Jack of all trades’ GPs with non-doctors would be less efficient to practices.

She said: ‘We don’t just see complex patients at 10-minute intervals [but] are also extremely efficient at managing a whole range of duties.’

Dr Nabi said GPs running practices were ‘being forced down this path because of workforce and funding issues’ but that ‘filling practices with non-doctors is nothing more than a sticking plaster approach’ that is ‘not really getting to the root of the issues’ - while potentially risking to ‘permanently change the landscape of NHS general practice forever’.

GPs might be ‘deskilled’ if they delegate to a breadth of non-doctors such as for example physiotherapists, she warned.

She added: ‘But for me personally the biggest issue in this is the loss of continuity of care. There is a real risk that with this reductionist approach to healthcare, we will just lose continuity and familiarity with one GP.

‘It will make it very difficult for us to manage complexity, because we will not have built up that relationship with the patient for the more simple illnesses.’

Arguing GPs should hire non-doctors to reduce workload, Dr Stephanie de Giorgio, a GP partner in Kent and co-founder of Resilient GP, said her practice had very successfully signed up to have trainee paramedic practitioner, whose home visits their patients were very satisfied with.

Dr de Giorgio said: ‘I have to say it completely revolutionised our working life when we had him and we could have afforded to keep him as a member of our own staff we would have… We came to trust his medical judgements… and what surprised me what that our patients absolutely loved [his home visits]…’

She further raised the benefits of medical personal assistants, for more complex medical admin, but stopped short of recommending the Government’s proposed option of replacing GPs with physician assistants, who due to their lack of training would only ever be a ‘dependent practitioner’.

She said: ‘I don’t think they are a good idea. I know there are a few working in GP surgeries around the country at the moment and in some places it goes really well. But the idea that they will fix the workforce crisis is yet another of Mr Hunt’s delusional thought processes.’

But arguing in favour of employing allied health professionals, she said: ‘I have huge respect for our armed forces and one of the things that they do well is use everyone they have in the most efficient way and to train them properly to do their jobs. They wouldn’t use a captain as a lookout on a quiet day on board a ship, just as they wouldn’t use a warrant officer to decide whether to launch a missile attack.

‘I think we need to be smarter about how we use ourselves and the rest of the primary care team.’

The motion in full:

’Filling practices with non-doctors will not solve the workforce crisis’

Readers' comments (19)

  • Why not go down the Job Centre and pick a dozen people in the queue and hand them a stethoscope and thermometer and stick them in local practices, seemingly anyone can do it!! The RCGP seniors very quiet about defending their own skills and expertise at being generalists. If our "superiors" think so little of themselves (that we can be so easily replaced with minimally trained noctors) no wonder the public / NHSE don't either.

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  • This will all come down to indemnity arrangements. GP partners are going to have to fork out for insurance cover for all the various flavours of doctors' assistant.

    The more the 'para-doctor' does the bigger the risks. There will be a delay between the introduction of new skill mix arrangements and the inevitable medico-legal cases and associated reputational and financial costs. (This happened in the out of hours services with an over-reliance on nurse practitioners.)

    I would be surprised if 'new ways of working' actually turn out, in the end, to be cheaper ways of working.

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  • All doctors should refuse to be liable for any non-doctors. The government should pay for any liability as it will have a kick on effect of making doctors who employ non-doctors have a higher premium.

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  • ‘But for me personally the biggest issue in this is the loss of continuity of care. There is a real risk that with this reductionist approach to healthcare, we will just lose continuity and familiarity with one GP.'
    one way of interpreting this is that we are needed 24/7 and anyone working less then that is not in a position to provide proper continuity of care and is, therefore, not acting as "proper" GP .

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  • Just say no! Turkey's shouldn't vote for christmas

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  • 9 O-levels, 1 AS-level, 4 A-levels, 5yr medical degree, DRCOG, MRCGP, JCPTGP, all those 80hr weekends, and 30yrs experience. How did it all come to this?
    Thank heavens I left GP.

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  • DRCOG ROTFLMFAO

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  • There are many things that only a GP can do - that difficult diagnosis, making a decision to change care for a complex patient. But we all of us use our practice nurses for patients whose management is well defined, and none of us enjoy processing discharge letters and ensuring the meds are the right ones and don't conflict.
    There's a place for these "non-doctors". I'm not saying I like it, but when you can't get doctors then we need these others to make a GP's work-life a little closer to being balanced.

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