Private providers competing for NHS contracts have declared GPs are ‘increasingly expensive’ and plan to phase them out in favour of using nurses and healthcare assistants for triage, diagnosis and management of simple conditions.
One leading company running out-of-hours services and referral management said it saw the potential for ‘radical change’ in its skill mix, while another has already made savings of 20% by managing half of patients in urgent care centres with nurses.
Leaders of private providers set out their stall at a major conference for the independent healthcare sector last week, and were told by health minister Earl Howe that the health bill presented them with ‘genuine opportunities’.
Andrew Gardner, chief executive of Harmoni, the largest private provider of primary care services, told the Independent Healthcare Forum that replacing GPs with nurses could allow companies to bid competitively for NHS services.
Mr Gardner presented a slide showing relatively simple conditions such as strep throat in one corner and difficult conditions such as depression in the other.
‘We need to change the skill set because you do not need a doctor to diagnose and administer a treatment for a strep throat, for example,’ he said.
‘We have a very expensive resource in GPs, and they are increasingly costly because of the growing shortage. So how can we start to use advanced nurse practitioners and healthcare assistants to work with the [simpler] conditions?’
Mr Gardner added: ‘If we can precisely diagnose conditions, we can use a lower and cheaper level of skill. We are looking to use nurses much more in the triage and visiting of patients. We think there is a big opportunity for radical change in the way we deliver that kind of service.’
Harmoni already delivers out-of-hours and urgent care services, and referral management centres, across over eight million people. Mr Gardner added: ‘For an organisation with a focus on growth, our cost base and improving quality of service, it is definitely something we are going to evaluate and implement in the coming months and years.’
Dr Mark Hunt, managing director of Care UK – which operates GP practices, and urgent care, walk-in and independent sector treatment centres – said changing the skill mix was an important element of its plans to take advantage of the opportunities offered by the health bill: ‘We run GP-led centres at the front of A&E in places like Ealing and Brent and 60-70% of patients are seen by our staff, with half now dealt with by nurse practitioners.
‘This change of the skill mix is already happening in a big way in our organisation and is the way forward,’ he said.
Dr Hunt, a GP in Frome, Somerset, added: ‘We see savings of about 20% through workforce efficiency on skill mix.’
Dr Helena McKeown, GPC member and a GP in Salisbury, said: ‘Using experienced nurses with enhanced training as part of a team including GPs can be a useful way to provide immediate primary care.’
But she added: ‘I would be alarmed if members of a team without adequate experience and training were put in positions of professional vulnerability, and healthcare assistants would need considerable experience, training and support to not put themselves or patients at risk.’
Dr Hans-Eric Usher, a GP for the UK Ministry of Defence in Germany, said working with the private German healthcare system reinforced his belief in the value of the NHS: ‘The ethos of the NHS – to provide best care at least cost through evidence-based treatment – goes out of the window when you involve private companies. It goes from save money to make money.’
The key players
Harmoni is the largest private provider of primary care services in the UK, with over 300 GP shareholders delivering patient care on behalf of the NHS for over eight million patients across England.
It is a major out-of-hours provider, and also runs 111 telephone services, GP-led health centres, urgent care centres, offender healthcare services and remote referral management.
Care UK is a leading private provider with approximately half a million service users each year. It runs 12 GP-led health centres, four out-of-hours services, one stand-alone NHS walk-in centre in central London and primary care services across 13 prisons.