General practice is in a workforce crisis like we have never known. We have been promised 5,000 extra GPs by 2020 but the current progress toward this target casts a dark and foreboding shadow of doubt. Despite this workforce crisis, patients continue to seek professional healthcare advice in record numbers showing that demand is outstripping capacity in this NHS on the brink of catastrophe.
A cynic might suggest that the 5,000 GPs are never going to arrive, that this statement was just a useful soundbite to silence the cry for help from the emergency LMCs conference calling for the undated resignations of our workforce.
The reality is that GPs are expensive, both in temporal and fiscal terms. It takes 10 years to grow a GP from scratch, costing a debatable £498,489. On top of this, GPs are expensive, demanding six figure sums for full time work. With a £20-30 billion funding shortfall expected by 2020 you can start to understand why expanding the GP workforce might not appear to be an affordable solution. Admittedly, this viewpoint requires you to overlook the argument of ‘getting what you pay for’: if you’re stuck on that, then don’t bother reading on.
One solution is to use physician associates. Indeed, we have seen that physicians associates have been used successfully across the pond, and our own Royal Colleges here in the UK seem to be advocating that we also pan this river of workforce gold. The arguments for and against this have been rehearsed in detail elsewhere, so I won’t labour these points.
In my mind, we already have an abundant resource that doesn’t need mining or panning, but needs refining and polishing. A workforce that, having completed five years of undergraduate education, sit in plain sight, already working hard in the NHS, waiting to be realised. These professional colleagues and friends gained the ability to prescribe independently in 2006 and are already nationally regulated and independently accountable for their actions. Furthermore, they are required to be indemnified against such actions, understanding the risks of litigation as we do in general practice. ‘Who are these professionals, who might answer our calls?’, I hear you ask. ‘Pharmacists,’ is my reply. I believe this profession is an element in current abundant supply whose potential as a malleable material is only just being realised.
In March 2016, there were 11,688 community pharmacies acting to serve the NHS in the UK with a total UK pharmacist population of around 61,000 souls. There is no secret that schools of pharmacy have overproduced pharmacists over the years leading to fears of unemployment. At approximately one third of the cost of a full time GP, is it not time to think about integrating pharmacists into the GP workforce?
For me, I do not want to employ a pill counter – I do not need one. What I really need is a GP but I cannot find or afford one. This is where Richard comes in. Richard is my friendly neighbourhood pharmacist. We started working together to optimise prescribing in my practice and it quickly dawned on me that Richard could do much more than this, so after a phone call to Richard’s indemnifier I gave him a stethoscope and we started to see patients together.
As a trainer, this was second nature to me and I quickly realised that the human body was second nature to Richard. Now, Richard is an integral part of my team. He sees, assesses and treats patients independently and I am sure with time he will understand complex patients and manage them just as I do.
The ability of this pharmacist seems only limited by our time to sit together and share learning and I know that he has learnt to use his education to diversify his practice according to the needs of the population. What I have learnt in return is that we already have an answer to our workforce crisis sitting in plain sight, should we choose to invest our time wisely.
‘There be gold in them there hills.’
Dr Dean Eggitt is a GP partner in South Yorkshire and medical secretary at Doncaster LMC