Rethink GP role and use nurses to ease workforce crisis, says report

General practice must extend the role of nurses, work closer with secondary care and train more GP specialists to plug the growing workforce gap, a leading think tank has warned.

King's Fund: report suggests short-term workforce fix
King's Fund: report suggests short-term workforce fix

A study by the King’s Fund called for radical remodelling of the NHS workforce to be integrated with the redesign of care.

The RCGP has called for 10,000 new GPs over the next decade to plug the workforce gap, but King's Fund director of policy and report author Candace Imison said general practice must think about how to bridge the gap in the short term with a ‘richer skills mix’ and greater use of healthcare assistants and nurses.

Current NHS contracts should be reviewed because they 'reinforce the divide between primary and secondary care doctors' and between medical and non-medical staff, the King's Fund report said.

It suggested a lower proportion of NHS funding should be spent training doctors. The NHS spends 60% of its funding on training the 12% of its staff who are doctors, but there is an 'urgent need to develop and invest in the unqualified workforce' such as healthcare assistants and care workers, the report argued.

The report said while there is a sharp focus on training new healthcare workers, an important, but often overlooked, consideration was retraining the existing workforce.

‘General practice needs to be thinking now about enhancing the skills of those they are working with. They need to think about how general practice can deliver a much more differentiated offer to people,’ said Ms Imison.

The rising challenge of multimorbidity, for example, meant the standard ten-minute consultation will become increasingly inadequate. Ms Imison said GP time could be released by expanding nurses' roles with other patients.

The future role of the GP could change with many more specialist GPs focusing on areas such as chronic illness. There will also be much closer working between GPs and specialists. Ms Imison said the divide between secondary and primary care doctors should be broken down so they work as a team rather than in tension, passing patients from one side to the other.

While there were examples of practices creating effective multidisciplinary working, Ms Imison said it was ‘very variable’.

‘There is clearly much further to go. And as GPs work increasingly in federations, you might find federations will have, say a physio working with it.’

The move to a federated model would provide the scale to allow practices to bring in specialist skills, she argued.

Ms Imison denied the report’s recommendations, focused on investment in healthcare assistants and nurses, greater use of volunteers and the breakup of national pay agreements, were about funding cuts. ‘It’s about making sure the money we do invest in the workforce has the greatest and most positive impact’, she said.

Ms Imison said general practice faced a crisis not only from a lack of GPs, but from the impact of the workforce gap in community and social care. GPs have an important role to play through engagement with local education and training boards to argue for the development of community and social care workforces, she said.

The report recommendations include:

  • Workforce redesign integrated with care redesign.
  • Workforce and service redesign need to go hand in hand. There should also be a review of current national contracts and pay.
  • Tackle the current cultural aversion to risk and fear of failure in order to promote experimentation, tolerate variation of the quality of service around the country, and be willing to close down experiments that are not working.
  • There is an urgent need to develop and invest in the unqualified workforce, such as health care assistants in hospitals, and care workers in the community. Given the growing shortage of informal carers we also need to consider new ways to attract and support volunteers in health and care.
  • Much greater priority needs to be given to developing the skills and competences of the current workforce, and the quality of teamworking.

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