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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