Speaking ahead of a presentation at the RCGP annual conference, Derbyshire GP Dr Gail Allsopp told GPonline that she had been ‘about to give up primary care’ - in part because of relentless workload and in part because of a difficult experience as an NHS whistleblower.
Her practice had been an ‘old-fashioned, small practice’ with a ‘doctor-heavy’ model of care - doctors were busy with large numbers of home visits and were often at the practice until late at night, she said.
But from 2016 she moved and began gradually with colleagues to introduce a new model - one that has meant GPs are now working at the ‘top of their ability’ as leaders of a primary care team, with more time to spend with patients who need it and able to leave on time at the end of the day.
GP wellbeing
GPs at the practice are now enjoying their work again - and Dr Allsopp says she now feels ‘I will never leave general practice’. Crucially, patients too have come round to accepting the model, after some initial resistance.
The practice has advanced nurse practitioners, doctors and pharmacists ‘all working to the top of the level they can do’, with GPs still working on the frontline, but with one on duty at all times in the consultant role - supporting and supervising the team.
Pharmacists have taken a huge block of workload off of GPs by handling all medication queries. Advanced allied health professionals with clinical pharmacy or nursing backgrounds take on all long-term conditions and acute appointments.
A nurse practitioner carries out all of the practice’s visits - calling back to the practice for support or advice where needed, discussing each visit and if necessary bringing photos back to support decision-making.
Consultant role
Dr Allsopp said: ‘In a normal practice, GPs do everything. Now we work more like hospital consultants - we are the experts in the building.
‘We are left with the very difficult, complex patients, but because we are not seeing as many in a day we have more time.
‘Each day there is a GP consultant in the building, and that person sees maybe six patients in a day. The rest of their time is blocked out to support and mentor pharmacists, nurses other practitioners in the building.’
She said whichever GP is carrying out the consultant role on a given day within the practice operates with an open door, and has other staff ‘in and out all the time like an SHO in a hospital’.
Supervision
The GP in this role monitors the consultations carried out by other staff, checking notes and calls in other staff to discuss if they spot anything of concern - treating them ‘a bit like GP registrars’.
Dr Allsopp said: ‘We haven’t found any difference between what happens with a nurse practitioner than what happens with us. Nurses and pharmacists come out having better communication skills than us in tests. If they think something is not right they can ask for advice, and we haven’t noticed an increase in referrals or worse prescribing - prescribing has gone down, referrals are low - none of the things people predict when you use AHPs have happened. I think that is because we have the time to supervise and mentor.’
The Derbyshire GP added: ‘I feel like I am working at the top of my game rather than slogging through patient after patient. I got to the point under the old model where my interruptions were being interrupted - with a full list of patients, busy constantly. I never get that feeling with this model.’
She said it was important not to work solely in a consultant role to avoid becoming de-skilled. But working in a standard GP role at the 4,700-patient practice has also been transformed.
‘As a standard GP, per session we see maybe 12 patients. Perhaps 12 in a morning, with maybe six booked in an afternoon with time for emergencies. Most emergency appointments are not used - so we can be proactive with our patients.
'Last winter when everyone else was saying they were stressed, we were not - we had spare appointments and lower acute appointments than expected. We didn’t hit crisis point.’
The practice has supported all its staff to pursue further studies and masters degrees to help them develop their capabilities. Dr Allsopp said many practices across the country may have adopted bits of her practice’s model - but have not committed to it fully in this way.
She said it was vital to introduce the change slowly to ease patients and staff into the new way of working - but urged practices struggling to cope to look closely at it.
Dr Allsopp said the new way of working meant GPs could ‘care for people like we did 10-15 years ago’. She said: ‘I come in on time and leave on time. We have spare appointments across the board. The team is much happier and I will never leave general practice - I feel my 20 years of experience are being used to the top of their potential - and I’m not now burnt out.’
