Under proposals drawn up by local NHS and council leaders GP numbers will fall, while practices will be expected to employ a greater range of new staff. Practices could also be merged to create larger organisations or integrated into foundation trusts.
The STP for Somerset is the second to propose a reduction in GP numbers over the coming years as part of NHS reforms. GPonline revealed in September that health bosses in east London were planning for the number of GPs required in the area to fall from over 600 today to around 400 in a decade’s time, while practices could be consolidated to serve populations of 10,000 or more.
The total primary care workforce in Somerset is set to rise by 43% between 2017 and 2021 under the plans, with new pharmacists, paramedics, counsellors, nurses and health coaches.
But the STP revealed that the ‘optimal’ number of whole time equivalent GPs under the proposals would fall from 310 to 254 over the five-year period.
The plan lists a further 20 returner or portfolio GPs that could be recruited by the end of of the period, although there is no indication how many hours' work those 20 would contribute.
The Somerset STP, one of only four to be led by a GP, is seeking to help overcome a projected deficit of £600m by 2021 by shifting care out of hospital.
Almost a third of GPs in the Somerset 'footprint' area plan to retire in the next three years with around 50% of vacancies currently unfilled.
The STP forecasts a 72% increase in weekly patient contact hours in primary care over the period, from 15,785 currently to 27,101 by 2020/21. GP face-to-face contact hours will fall by around 12% over the same period under the plan, dropping from 5,913 for 2016/17 to 5,226 by 2020/21, with much of the additional patient contact time delivered by extra paramedics, nurses, nurse practitioners, pharmacists and other staff to be recruited under the plans.
The projected £8.3m additional cost of the new staffing model is assumed in the plan to be met through service redesign and consolidation by practices themselves as well as commissioner investment.
Practices will be responsible for arrangements for employing the new range of staff and will be expected to share or outsource admin functions and share staff. Practices could also be expected to merge to form ‘more sustainable’ organisations.
Enhanced primary care
Health leaders in Somerset are planning a new model of integrated, enhanced primary care with a the broader skills mix, and building on the local Symphony primary and acute systems (PACS) vanguard in which a local hospital foundation trust and GP federations are developing a joint venture integrated provider.
The plan revealed that more practices are expected to be integrated with foundation trusts while the number of traditional partnership practices will decrease.
Commissioners will be expected to deliver the funding commitments set out in the GP Forward View and CCG primary care investment.
Under the new Somerset model all patients will have an individual proactive care plan, and primary care practice teams will be supported by wider social care, mental and complex health teams through multidisciplinary meetings.
Same-day demand is expected to be managed by groups of practices under the plan and seven-day enhanced GP services provided through hubs.
An accountable care organisation will be in place in Somerset by 2019, according to the plan.
Somerset STP leader, GP Dr Matthew Dolman said: ‘Doing nothing is neither desirable nor sustainable, and that’s the case across the country. The health and care system in Somerset needs real change which puts prevention at its heart.
‘We haven’t kept pace with the changing demands and this is the opportunity to address that and focus on keeping people healthy, independent and in their own homes and communities for as long as possible. Where people do need hospital treatment, we want to make sure they can get home as quickly as possible.
‘It is essential that health and social care are financially sustainable. If we continue spending beyond our means we will struggle to maintain good, safe services.
‘Our plan is as challenging as it is ambitious, but we are all working together and determined to make it happen with the input and support of local people.
‘This is just the start of a process. It sets out a way forward but one we are committed to discussing and developing with patients, carers and the wider public.’