The GP Forward View (GPFV) commits £206 million towards measures to grow the medical and non-medical workforce. Much emphasis has been put on the plans to train an additional 5,000 GPs by 2020, but what other differences might you see in your practice by 2020/21?
1. Access to a clinical pharmacist for two or three sessions a week
The GPFV’s finance package of one pharmacist per 30,000 patients means that the average practice would only have the pharmacist for perhaps two or three sessions per week. On the plus side, as there has been an over-supply of pharmacy graduates for the last few years, there is already a qualified workforce that could quickly develop into new roles within primary care. Encouraging more pharmacists to undertake training to become independent prescribers could also support the GP workload.
2. More nurses, maybe including nursing associates
The GPFV involves investing in a range of measures to increase the number of nurses in primary care. These may include nursing associates, a new role currently being reviewed following a public consultation by Health Education England. Nursing associates would bridge the gap between fully qualified nurses and existing health care support workers such as health care assistants. They would deliver more of the hands-on care, freeing up time for existing nurses to focus on clinical decision-making. They would also have a focused career development route towards becoming fully registered nurses. Other strategies to attract more nurses include: more pre-registration nurse placements in general practice, support for return to work and retention schemes and access to mentorship training. Interestingly, nurse leaders have noted that the GPFV focuses much more on developing core nursing competences at scale, rather than developing the more advanced nursing competencies of diagnosing and prescribing, as with nurse practitioners, arguing that this is perhaps a missed opportunity.
3. More care navigation roles being undertaken by receptionists and clerical staff
The GPFV commits £45 million per year to training staff on which services, resources and innovations are available within the local health, social care and voluntary sectors. The aim is to appropriately signpost patients away from the GP as the first port of call for all problems. Practice staff will also be trained to handle more clinical paperwork, freeing GPs up to focus on clinical decision-making around patient care.
4. More mental health therapy services
The GPFV is also proposing investment in an extra full time therapist for every two to three typical sized GP practices. This is to expand access to the Improving Access to Psychological Therapies (IAPT) programme, which uses both psychological wellbeing practitioners and cognitive behavioural therapists. Having more practice-based therapist support may encourage engagement by certain groups who currently have comparatively poor access, such as older people and those with long term conditions.
5. Maybe a physician associate (PA) or a medical assistant
These roles are being piloted at a relatively small scale, with a planned 1,000 physician associates and an unspecified number of medical assistants. PAs undertake two years full time post-graduate training and then work under the supervision of a GP to undertake face-to-face patient consultations, telephone triage and home visits. Under GP supervision, they can request diagnostics and perform therapeutic procedures like inserting coils and contraceptive implants. An experienced PA may generate a ‘review rate’ of around 10%. Recent research in the British Journal of General Practice found that for same-day appointments, there were no differences in either the rates of diagnostic tests ordered, patient satisfaction, or re-consultation for the same or linked problem between PAs and GPs seeing these patients. The adjusted average PA consultation was 5.8 minutes longer than the GP consultation and cost £6.22 less for the PA than the GP. Medical assistants are able to deal with administrative and electronic tasks including reviewing test results, emails and arranging follow-up appointments, freeing GPs to deal instead with clinical decision-making tasks.
Practices can expect to be offered opportunities in the next five years that increase their capacity for core primary care functions. This will be through a mixture of up-scaling existing roles and introducing newer skill-mixing roles. It remains to be seen if these opportunities are sufficient to pull general practice back from the edge.
Dr Anita Goraya, FRCGP is a director at Ernst and Young’s healthcare advisory practice