Exclusive: Most GPs back skill mix as part of solution to workforce crisis

More than half of GPs think that increasing the skill mix in their practices could help address the current shortage of GPs, a GPonline survey suggests.

A GPonline opinion survey carried out last month, found that 52% of GPs polled suggested a wider skill mix in practices would be at least part of the solution to GP recruitment and retention problems.

However, more than one third (35%) said it was not part of the solution, while 12% were unsure.

The GP Forward View, published in April, stated that patient demand and GP shortages meant that GPs no longer had the time to use their expertise on patient issues that could be safely and competently managed by others.

General practice team

‘Wider members of the practice-based team will play an increasing role in providing day-to-day co-ordination and delivery of care,’ it said.

‘Greater use of skill mix will be key to releasing capacity, if we are to offer patients with complex or multiple long-term conditions longer GP consultations.’

But GPs at this year’s LMC conference rejected calls for an increased skill mix to meet workforce problems. In a ‘themed debate’ doctors said the workforce crisis had forced practices to increase their skill mix, but often without proper funding or support.

One GP who responded to the poll and supported the introduction of a wider skill mix in practices said: ‘It's one of the only valid current solutions. Good nurse practitioners can make a huge difference, as can practice pharmacists. We're trying to do too much ourselves and need to be more comfortable letting go of some of the workload for the sake of being more sure of safety and future-proofing.’

Another supportive GP said: ‘Our nurse practitioners are invaluable. We would welcome physios, pharmacists and mental health practitioners on the team.’

Skill mix

Many GPs polled supported the increased skill mix, but with reservations.

One said: ‘We already have a skill mix in our practice. The problem is patient expectations have changed. Consultations have become more challenging and stressful.'

And another GP said: ‘Yes, skill mix is important but has a ceiling on its usefulness. I think it is currently essential to manage workload, but is a sticking plaster to a spiralling problem.’

Some GPs who responded to the survey suggested attracting more GPs to the profession by arresting the decline in earnings, rather than skill mix, was the only solution to the workforce crisis.

One GP commented: ‘[Skill mix] is a cheap but ineffective way to deal with the problem. It will however lead to over-prescribing, over-investigation and over-referral. The way to improve the situation is to increase the number of skilled GPs. That is only achieved by increasing earnings. All other approaches will fail.’

NHS funding

Another said: ‘It is a sticking plaster on a very large wound.’

GPC deputy chairman Dr Richard Vautrey said practices will need to develop their skill mix in the coming years as they try to maintain services to patients at a time when there are not enough doctors wanting to be GPs.

‘Practices have done this for the last decade in innovative ways and are likely to continue to do so,’ he said.

‘However there is also a shortage of practice nurses and mental health therapists so it's not always easy to recruit to posts. The relative cut in funding going in to general practice has also had a big impact, with practices having insufficient resources to expand their practice teams or to develop their premises to give them space to enable them to do this. Practices need NHS England and governments across the UK to commit to a sustained and significant increase in funding to give them the confidence that the resources will be available for them to take on more staff.’

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