Exclusive: New models of care could fail to cut GP workload, warns RCGP expert

New models of care being rolled out by NHS England may not lead to reduced GP workload, the RCGP's workforce lead has said.

Professor Amanda Howe: no guarantee of GP workload reduction (Photo: Pete Hill)
Professor Amanda Howe: no guarantee of GP workload reduction (Photo: Pete Hill)

College vice-chairwoman Professor Amanda Howe said that while new models could lead to a better service for patients and a better-quality workload for GPs, she was not sure new integrated arrangements would necessarily help ease the workload pressure.

Professor Howe was speaking to GPonline ahead of the publication next month of a report by the primary care workforce commission set up by Health Education England (HEE). Professor Howe sat on the commission ordered by Jeremy Hunt last October to examine the future primary care workforce requirements.

Speaking in her RCGP capacity, Professor Howe said that over the next five to seven years as new care models were developed, there was no guarantee of reduced GP workload. ‘I don't think you'll see a huge amount of time saved for general practice,' she said.

Routine GP care

While the expansion of the primary care team would reduce the amount of time GPs spend on routine work such as talking through lifestyle changes or medications, doctors will have to spend more time on more complex cases which are being increasingly managed out of hospital, Professor Howe argued.

‘I need more time with the complicated medical patient, who we are now getting given to us in the community to go on with,' she said. 'So I'm not sure how much new models of care will save GP time. What I think they will do is give better service for the community and some exciting teams to work with.' GPs, she said, would be just as busy in future, but ‘doing better stuff’.

New care models outlined in NHS England’s Five Year Forward View are being rolled out by vanguard schemes. The models include hospital-led vertical integration of acute and primary care,and GP practice-led integration of out-of-hospital services.

Professor Howe said that the expansion of primary care enabling more care in the community would be good for patients, but warned the schemes needed to be properly resourced and evaluated.

I don't think you'll see a huge amount of time saved for general practice."

Professor Amanda Howe, RCGP workforce lead

‘The health service isn't always very good at putting money aside for evaluation of new innovation. I like to see evidence from real-time experiments. That will be money well spent, as we see new configurations, and teams or federations working things out in slightly different ways, how we’ll provide extended hours, how will we provide out-of-hours? People will experiment if they've got the additional resource, and the opportunity to use the workforce, but then we need to know what works.’

She added: ‘I think what we'll see in the next five years, providing we don't all get so overwhelmed we can't do it, is we'll see new models of care being implemented. We ought to be seeing good evaluation data come out of that about what works and what doesn't.’

Health secretary Jeremy Hunt repeated last week that he was committed to tackling GP workload by reducing administrative burdens through the GP contract.

Mr Hunt has said previously that transforming general practice over the next five years will make the profession more attractive to medical graduates. The government has promised 5,000 new GPs.

GP workforce policy

Professor Howe said the independent commission on workforce aimed to put ‘flesh on the bone’ of workforce policy. ‘All the parties before the election seemed to be talking about it. Then the question is, how do you make that a reality? And if you put the money in, how does it translate into people in the workforce?’

The commission, she said, was looking at ‘how are we going to begin to do this and what do we need to do to help people to do in their own places, their own federations, their own localities, to re-empower primary care to do the job it is really good at'.

On the government’s plans to recruit 5,000 new GPs by 2020, Professor Howe said despite scepticism from much of the profession, she believes the target is achievable.

The 10-point plan on GP recruitment,retention and returners launched by NHS England, HEE, the RCGP and the BMA in January set out an effective strategy, said Professor Howe. ‘If you stack that up, like a really systematic operational plan, you have got some chance of getting some of those numbers in,' she said. ‘I know that government hasn't put flesh on that yet. That's what we have to help them do, and everybody needs to rally together.’

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