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GPs increasingly relying on practice nurses, concludes national audit

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GPs are increasingly turning to practice nurses and other staff to manage demand for primary care services, according to a national audit.

The National Audit Office has published findings from a review of patients’ experience of accessing general practice in England during 2014-15.

As part of its review, the NAO looked at how practices were managing patient demand by using different types of staff.

It noted that the proportion of consultations handled by nurses or other general practice staff, rather than GPs, increased from 25% in 1995-96 to 38% in 2008-09.

“The limited data collected since then suggest that this trend has continued, supported by a significant increase in the number of other staff providing patient care over the past 10 years,” stated the report – titled Stocktake of access to general practice in England.

The NAO noted research supporting the trend carried out by the Nuffield Trust. The think-tank found that, in its sample, between 2010-11 and 2013-14, GP consultations increased by only 0.6% a year, compared with 2.6% for those with nurses.

Meanwhile, the NAO highlighted that a survey it carried out in September 2015 indicated that patients “may often be willing to see other staff” instead of a GP.

For example, it noted that 65% of survey respondents felt it was acceptable to consult a nurse if their GP was not available.

But it added that the evidence was “inconclusive when we examined the effect of making greater use of nurses on patient experience”.

Overall, the NAO found that, as of September 2014, only 29% of the general practice workforce were GPs, while 12% were practice nurses, 7% were other staff providing direct patient care and 51% were defined as administrative, clerical and other staff.

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However, the NAO noted that different practices “vary significantly” in their staffing mix.

For example, one practice with approximately 7,000 patients employed seven GPs and one nurse, compared with a similar-sized practice that employed four GPs and seven nurses.

It also observed that the workforce in general practice was “typically slightly older” than in other parts of the NHS.

In 2014, an estimated 28% of whole-time equivalent nurses working in general practice were aged 55 or over, compared with 13% working in hospital, community and mental health services.

However, the NAO warned that data on the general practice workforce was “not complete”, making it harder to specifically identify where pressures were greatest and where more capacity is needed.

Such gaps included data on the recruitment and retention of practice nurses and also the use of locum GPs, it said.

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