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GP workload 'crisis' being absorbed by practice nurses

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The increasing demand for primary care consultations is being absorbed by nurses and other practice staff, rather than GPs, according to latest data analysis.

Trends identified by the Nuffield Trust think-tank show that the rise in the number of consultations being carried out by practice nurses is far outstripping a similar rise for GPs.

Natasha Curry, a senior fellow in health policy at the trust, highlighted that headlines about a “crisis” in general practice had become commonplace over the last year or so, with medical bodies describing a chronic shortage of GPs.

To investigate, the Nuffield Trust analysed a subset of GP practice data taken from 337 practices in England between 2010-11 and 2013-14.

She noted that the data revealed that patient pressure on primary care services as a whole had certainly increased.

“Consultations with GPs rose by approximately 2%, whereas consultations with nurses rose by 8%”

Natasha Curry

Among the practices analysed, the total number of consultations rose by around 11% over the three-year period looked at. The number of consultations per person per year registered on a practice list also rose – from 7.6 to 8.3

This was supported by previous estimates that suggested the number of consultations in general practice had risen by 13% between 2008 and 2013.

But Ms Curry said that, while activity in general practice had increased, most of that increase was among staff groups “other than GPs”.

“Consultations with GPs rose by approximately 2%, whereas consultations with nurses rose by 8% and consultations with ‘other’ staff – a long list of professionals including pharmacists, physiotherapists, and speech therapists – grew by 18%,” she said.

The think-tank said that, although it was “cautious” about extrapolating national trends, its dataset was the most extensive used as a basis for published research on the issue of GP demand since 2009.

Ms Curry added: “Our analysis provides some insight into what has happened to consultation trends since the last formal publication of estimates in 2009, showing that the largest increases appear to be for nurses and staff other than GPs.

“That raises questions about the assumption that a rapidly rising number of consultations is driving pressure on GPs,” she said.

Ms Curry noted that, while it was clear GPs believed they were experiencing “rising and unsustainable” workloads, it was not clear “exactly where that pressure is coming from”.

The findings were revealed in a recent blog by Ms Curry on the Nuffield Trust website.

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Readers' comments (1)

  • The press are always highlighting the GP's plight but in truth GPs have a number of staff who are first responders to patient calls and to whom the GP can refer without actually seeing the patient. Many GP registered patients over the age of 65 are known to their Community care teams - often due to their co-morbidities, complexity and vulnerability. The expectation is that these teams will see the patient, certainly initially, in preference to the GP. I'd be interested in Ms Curry delving more broadly into this subject and take a chance to perhaps look at increased work & rising pressures on community health staff. Community healthcare has become more about teamwork between Primary & Community care, the Practice nurses run, among other responsibilities, the GPs clinics & registers (stats for which GPs receive payment) and Community teams the physical & mental health care & management of people in their homes, Rest Homes and, in some areas, Nursing Homes. In all instances patients can be referred to their GPs (or specialist nursing & medical staff) but most issues are resolved before that necessity. The Community Matrons liaise on a daily basis with their GPs to optimise care & these relationships are still being developed.

    My professional experience is that the Community NHS Trust staff (Community Matrons & Community Nurses) caseloads are ever rising because many hold enhanced skills such as patient examination, diagnosis and prescribing thus freeing up the GP's time.

    It may be that GP Practices would benefit from employing senior nurses with enhanced skills to help with the numbers of Practice patients seeking medical advice or even Primary care & Community care being amalgamated and truly working as one. Ms Curry noted, it was not clear 'exactly where that pressure is coming from'. Again from professional experience one wonders if the recent changes where GPs have been required to assume the driving seat of commissioning there has only been an approximately 2% rise in consultations but possibly hours more on commissioning?

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