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”.
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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.
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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”.
“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.”