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Broaden primary care skill-mix to tackle GP shortfall, says review


A raft of recommendations have been made by a major review into the sustainability of the primary care workforce, including greater use of physician associates and healthcare assistants.

Health secretary Jeremy Hunt in October commissioned Health Education England to conduct an area by area examination of general practice capacity, after admitting current assessments involved guesswork.

The resulting Primary Care Workforce Commission was led by Martin Roland, professor of health services research at the University of Cambridge.

His commission’s report, published yesterday, argued there would be “substantial potential benefits” from a “range of new approaches to staffing”, including greater use of new professions, such as physician associates – previousy known as physician assistants – and healthcare assistants, within GP practices.

Mr Hunt promised additional 1,000 physician associates by 2020 as part of the government’s “new deal” for general practice, announced last month. The health secretary also promised 5,000 additional GPs. Yesterday’s report warned that “national targets for GP numbers should be regularly reviewed”.

Meanwhile, it suggested that paramedics could substitute for GPs in assessing of urgent requests for home visits, but also warned that the “relatively unskilled workforce” currently used for out-of-hours triage “may be a cause of hospital overuse”.

“The costs and benefits of using a relatively unskilled workforce to triage requests for out-of-hours care are not sufficiently well established and may be a cause of hospital overuse, the report said. “Research is needed to compare skilled versus less-skilled staff providing telephone triage in out-of-hours care.”

As recently reported by Nursing Times, managers at a successful nurse-led practice in London have suggested their service model could be replicated elsewhere as another solution to the GP shortage.

In addition, the commission’s report argued for a much greater use of technology, noting that there should be a general practice electronic record used by all primary care staff, including community nurses and health visitors. It also called for data to be publicly available on the quality of primary care.

Among its 38 recommendations were access to a named paediatrician and a named children’s nurse in GP practices, and a named consultant psychiatrist and a named mental health worker in every practice or groups of practices.

The report also suggested that contracts for district and community nursing services should increasingly be awarded to organisations providing a range of integrated services as opposed to single community trusts.

It called for contracts for community nursing services and GP out-of-hours care to require bidders to “demonstrate they have the ability to integrate well with other primary care providers”.

University of Cambridge

Professor Martin Roland

“This will encourage contracts to be held by organisations representing primary care providers, for example, federations of GP practices, multi-specialty community providers or primary and acute care systems, rather than by stand-alone providers or community trusts,” the report said.

Responding to the commission’s report, Royal College of GPs chair Maureen Baker said she was “open to widening the skill-mix in general practice”.

But she warned: “These will never be a substitute for GPs. Any new roles, such as medical assistants, must be properly piloted and evaluated to ensure that they can add value to patient care in general practice.”


Readers' comments (2)

  • The writing has been on the wall for has been plain and obvious that the day would arrive where the NHS would be short of GPs (and all the other professionals who make up General Practice).
    I have been asking my employers for years, for further educational development and appropriate qualifications, to 'firm up' my position and qualify me for the job I am already doing (that of Nurse Practitioner).
    I have always been refused the opportunity to do further (essential) courses by my employers....despite lengthy explanations as to why they should be sending me off to get the qualifications for the job I am already doing.
    In the past, I have spent time talking with my union, NMC and LHBs etc to try and highlight this situation - all efforts fell on deaf ears, no one wanted to know.

    This issue should have been properly addressed years ago and not this endless round of stating the obvious and then doing nothing about it.
    Lets hope this gets things going, finally.

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  • We have been training paramedics for 10 years to expand their skills- they are fab.But not all Ambulance services buy into this.
    We also need to ensure nursing courses are full- at the moment they are not

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