Dr Maureen Baker: Skill-mix has a vital role in general practice

The way we work is changing. We have to adapt and it is imperative that we embrace new ways of working in order to safeguard our profession and ensure that we have a general practice service fit for the 21st century.

Our patients are living longer and the numbers of those presenting with multiple morbidities are soaring. The traditional 10-minute consultation is increasingly unfit for purpose yet we are carrying out 150,000 more consultations every day than we did five years ago and the GP workforce has remained relatively stagnant.

We must to do everything in our power to ‘recruit, retain, return’ thousands more GPs over the next five years. But this will not happen overnight so we need to look at alternative solutions to our workforce and workload pressures, that will work both in the short term and the long term.

Pharmacists in general practice

In March this year, we unveiled joint proposals with the Royal Pharmaceutical Society to employ pharmacists as part of the general practice team to help reduce GP workload and cut waiting times for a GP appointment.

We are delighted that these proposals have been swiftly supported by NHS England and earlier this month, NHS chief executive Simon Stevens announced a £15m pilot scheme to get this off the ground.

This arrangement is already working successfully in some GP surgeries and we hope that this injection of money will be a catalyst for more GPs and their teams to participate.

We now need to come up with robust key performance indicators by which we can evaluate the pilot scheme and I would welcome your input.

These could include the proportion of medical reviews undertaken, actions taken on medicines reconciliation, or audits on medicines errors. We need a suitable mechanism to measure how the scheme has benefited patient care and helped reduce GP workload.

The case for skill-mix is getting stronger

Broadening the skill-mix in general practice is something we have advocated for and the case seems to be getting stronger by the day. Last week the Primary Care Workforce Commission recommended greater use of pharmacists, physician associates and healthcare assistants in general practice to alleviate pressure on overstretched GPs.

We are keen to secure government funding to implement a medical assistant pilot scheme, to see how this role would translate into UK general practice.
 
But introducing new roles needs careful consideration and should not be taken lightly. We also need robust piloting and evaluation to ensure that these schemes are workable and that they actually add the value that they promise.
 
The proposed role of physician associates is causing consternation amongst some GPs, although there is no suggestion that they will be a substitute for family doctors.

There was also the example of ShropDoc’s advert for a 'community physician' this month - a role that apparently entailed providing GMS consultations without speciality training in general practice. This clearly hadn’t been properly thought out, and to their credit ShropDoc quickly withdrew the advert and admitted that it has been published in error.
 
This brings home how careful we need to be about the different roles we are introducing to general practice. Our profession and our patients’ care cannot be compromised by quick-fix solutions.

It is important that we adapt and change for the future but the unique strengths of general practice must not be sacrificed in the process.

  • Dr Baker is chairwoman of the RCGP and a GP in Lincoln

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