Paramedics and medical assistants can ease GP workload, finds workforce commission

Paramedics could 'substitute for GPs' in some cases, while use of pharmacists and other staff in primary care must be widened to help tackle the workforce crisis, a landmark GP workforce commission has found.

Professor Martin Roland: led GP workforce commission
Professor Martin Roland: led GP workforce commission

The independent Primary Care Workforce Commission, established by Health Education England (HEE) in 2014, called for rapid implementation of the 10-point plan launched by the RCGP, BMA, NHS England and HEE.

The commission’s report, The future of primary care: creating teams for tomorrow, called for greater use of pharmacists, physician associates and healthcare assistants and a workforce plan for primary care nursing.

The report also called for fundamental changes to NHS funding mechanisms to incentivise integrated care across sectors.

Read more: RCGP response in full

Among its more radical recommendations the commission, chaired by professor of health services research at the University of Cambridge, Martin Roland, called for piloting and evaluation of the potential benefits of using ‘paramedics to substitute for GPs’ in the assessment of urgent requests for home visits.

The report cited GPs’ excessive administrative burden as a major cause of doctors leaving the profession. It said there is ‘a case for training support staff, including healthcare assistants and existing administrative staff, to assist healthcare professionals in the administrative aspects of their work.’.

The commission, whose members included RCGP vice-chairwoman and workforce lead professor Amanda Howe, and professor of general practice and primary care at Durham University Greg Rubin, also called for practices to be organised so that a ‘significant’ number of consultations are longer than at present.

Health secretary Jeremy Hunt ordered the commision in October 2014 in response to the GP workforce crisis. Mr Hunt also pledged to take on 5,000 new GPs by 2020: a target which has been watered down in recent weeks from a minimum to a maximum figure.

While calling for the 5,000 target to be implemented, the commission recommended it be regularly reviewed.

GP workforce crisis

RCGP chairwoman Dr Maureen Baker said: ‘Professor Roland’s report could prove to be a valuable lifeline to help rescue general practice from years of neglect and under-investment and ensure that we can continue to deliver good and safe care to our patients well into the future.’

‘We welcome the Commission’s call for rapid implementation of the 10-point plan, launched jointly by the RCGP,  NHS England, HEE and the BMA earlier this year to build the GP workforce.

‘While the Commission’s report is aspirational for the future of primary care, it also shows a lot of common sense, particularly in calling for a shift in funding from secondary to primary care.

‘By strengthening general practice, we alleviate pressure across the health service by ensuring that more patients are cared for close to home where care is cheaper and where our patients want it most.

‘But we recognise that general practice itself also has to adapt and change.

 ‘We welcome the report’s backing of new models of care, particularly federations, which the college pioneered, and which we are currently involved in mapping out across the country.

‘We are also open to widening the skill-mix in general practice, with the introduction of roles such as practice-based pharmacists to take on some of the tasks that do not necessarily need to be done by a GP.

‘These will never be a substitute for GPs so 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.’

Roland Commission recommendations: 

  • Short and long term plans to increase recruitment and retention. Implement the NHSE, HEE, BMA, RCGP 10-point plan and government 5,000 GPs target. 'National targets for GP numbers should be regularly reviewed. There should also be scope to adjust plans at local level providing that those plans can be demonstrated to meet local need.'

  • Equivalent measures to 10-point plan for  primary care nursing.

  • Greater use of pharmacists in management of people on long-term medication and people in care homes.

  • Wider use should be made of community pharmacists and pharmacy support staff in managing minor illness and advising people about optimising their medicines.

  • Benefits from a range of new staffing approaches including 'wider use of physician associates and healthcare assistants. The potential for paramedics to substitute for GPs in the assessment of urgent requests for home visits merits further evaluation'.

  • Development and evaluation of new support staff roles to tack on admin burden.

  • 24-hour community nursing services should be available in all areas

  • Research is needed to compare skilled versus less-skilled staff providing telephone triage in out-of-hours care.

  • Practices need protected time to support team working: ‘contractual and employment arrangements for staff in primary care should include time to support professional activities focused on quality improvement and clinical governance .’

  • Contracts for community nursing services and GP out-of-hours care should require bidders to demonstrate they have the ability to integrate well with other primary care providers, encouraging practice federations or MCPs rather than stand alone providers to take contracts.

  • General practices should be organised so that a significant proportion of face-to-face consultations can be longer.

  • Structured training opportunities should be available to GPs who wish to develop extended clinical, academic or leadership roles.

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