Primary care experts outline ways to save general practice

GPs and other primary care experts have set out how better use of skill mix, support for primary care out-of-hours and support for ageing patients can help ease soaring pressure on primary care.

Practice pharmacist Ravi Sharma
Practice pharmacist Ravi Sharma

In a one-hour debate at the RCGP annual conference in Harrogate on Thursday, a panel of GPs along with other clinicians and patient representatives set out their solutions to the crisis facing general practice.

RCGP Scotland deputy chair of policy Dr Elaine McNaughton told the conference that the 2004 GP contract had fragmented primary care, and the profession should consider taking back control of out-of-hours care - with full control of funding - to help bridge the gap between in-hours and out-of-hours care.

She pointed out that the bulk of hours of the week were out-of-hours, and raised concerns about low numbers of GPs involved outside daytime work, warning that GPs were in danger of losing the ability and confidence to work out-of-hours.

RCGP vice chair Dr Tim Ballard backed a GP speaking from the floor in the debate who said it could be easier to argue for four-year GP training if it involved a mandatory six-month spell in out-of-hours, which could 'pay for itself'.

New models of care

RCGP clinical lead for commissioning Dr David Paynton said GPs had to embrace the fact that the NHS many of them trained in was no longer around, and that new ways of working - sharing responsibility and roles with social workers, pharmacists, nurses and many others were vital.

'Fundamentally the solution is we have to lead the solution,' he said. There are things we can do around sustainability and transformation plans but we need to fundamentally review how we work ourselves, we need to grasp this ourselves.'

He said GPs could not lead the wider primary care team through a 'traditional, hierarchical model'. 'I see a leadership that is enabling that allows every member of primary care team to take a lead in areas and lead parts of the local system. To enable us to have belief in ourselves again.'

National Association of Patient Participation chair Dr Patricia Wilkie argued that empowering patients was the key to saving general practice. She told the conference: 'Involve patients in your problems. Tell us about the pressures that you are facing and discuss with us what you think needs to be done.

'Be open and honest with us and treat us as partners - the marriage between patients and general practice is a very powerful marriage, I can assure you. Individual patients can help save general practice by knowing when, where and with whom to consult.'

Patient involvement

She argued that strong patient participation groups could educate patients, and help put GPs in touch with social prescribing opportunities that could ease their workload.

Royal College of Nursing advance nurse practitioner forum chair Wendy Fairhurst warned that the lack of a clear structure for career progression for primary care nurses was limiting the role they could play in supporting general practice.

She argued that advanced nurses - capable of prescribing and working largely independently - could take on a huge proportion of GP workload. But she warned that nurses in training were currently not offered training in primary care as a matter of course.

'When nurses complete training, they can manage a ward, look after IVs,' she said. 'Why can't they leave training able to look after patients with long-term conditions or do smears?'

Clear structures for career progression, and practices employing senior nurses across federations or other models of care at scale would attract more nurses into the profession and help make the maximum use of the existing workforce, she argued.

Community pharmacy

Ravi Sharma, a lead practice pharmacist from London, told the conference that community pharmacists had millions of contacts with patients a year, creating a huge opportunity to integrate with GP services and ease the burden on general practice by helping to manage patients with long-term conditions and carry out medicines reviews.

In some areas pharmacies were working with full access to GP patient records, but integration needed to be adopted far more widely, he argued. Sustainability and transformation plans (STPs) being drawn up across the NHS needed to involve pharmacy from the outset, he warned.

Consultant gynaecologist Nick Panay said that women 'now spend half their lives in a post-menopausal state' and called for GPs to target women around the menopause to empower them to manage their health.

Full coverage of RCGP annual conference

Photo: Pete Hill

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