It is no secret that the NHS is critically short of GPs. Yet obstacles to solving this problem appear to exist wherever you look.
Nt editorial heather maughan
A perfect storm of increased workload, decreasing numbers of new GPs and under investment has led to challenges within the profession that if not addressed immediately, will lead to a decline in the quality of service available to patients.
In an urgent care setting, this problem is even more critical as the pool of GPs that will work out of hours is much smaller.
One way to tackle the issue is to utilise other healthcare professionals more by tapping into the next best available, or I would argue, sometimes more appropriate skillset.
In my opinion, the model recommended by Sir Bruce Keogh advocating integrated urgent and emergency care greatly helps to reduce the burden on A&E and improve the patient experience.
While it is a positive step, for the model to work effectively it requires urgent care providers to shape a more flexible workforce to meet the needs of these new centres.
That means understanding in detail the skill set of individual healthcare professionals so that they can be matched with the skills required by the urgent care setting.
Urgent care centres commonly include minor injury services for example, yet GPs don’t treat minor injuries and Advanced Nurse Practioners (ANPs) are often not minor injury trained. Here we need to utilise the skills of the Emergency Nurse Practitioners (ENPs), who come from an A&E background and Emergency Care Practitioners (ECPs) who come from a paramedic background, as an essential part of the workforce delivering care for minor injuries.
Other healthcare practitioners are equally as important, particularly where the urgent care centre is offering a triage streaming service. Paramedics, for example, are experts at streaming patients so are perfectly placed to do this in urgent care settings, whereas ANPs are more skilled at assessing patients which is a different skill entirely.
”There is also an opportunity within the 111 service to better utilise pharmacists”
There is also an opportunity within the 111 service to better utilise pharmacists who have strong clinical assessment skills. Overdose calls, medication enquiries and minor injuries can all be dealt with by a pharmacist instead of a GP.
They can also respond to repeat prescription enquiries over bank holidays and weekends and in doing so, avoid the calls going through to the GP out of hours service. With their local knowledge of pharmacies, they can assist patients in sourcing medication, making them better placed to deal with these enquiries than any other healthcare professional.
Looking at the whole team more holistically and identifying individual skills within the urgent care setting, including 111 services, will in turn identify the skills gaps that need to be filled. It is unrealistic to resource GPs for everything, so it is essential to upskill nursing staff in order to shape the workforce to fit with the demand in each locality.
While it does mean that staff rotas become more sophisticated and a lot more complex to manage, the approach goes a long way to solving the problem of a shortage of GPs in the short term, while enhancing the quality of patient care.
Where GP only contracts still exist in urgent care settings, they condemn local populations using out of hours services to longer waiting times, when in reality, adding nurses and other healthcare practitioners into the mix will ultimately lead to patients being seen quicker, resulting in a better patient experience.
Heather Maughan is Head of Nursing at Vocare