To cope with rising demand and the ageing population and the need to expand out-of-hospital services, GP partnership review chair Dr Nigel Watson called for a 'greater focus on practices working together in natural communities of care (consisting of populations of 30-50,000) with additional services embedded in practices and supporting them to improve the outcomes for their population'.
In his third blog since the launch of the review in May, he argued that forming these communities could be achieved by practice mergers, or by smaller practices forming networks.
He added: 'We need to start seeing the potential of additional resources being made available at a local level as a potential benefit to our practices. With adequately resourced clinical leadership we can use existing resources more effectively and with additional resources this will help to support practices and may be one way that the partnership model can be revitalised.'
Dr Watson's support for practices working across groups of 30-50,000 patients comes just over a year after NHS England unveiled plans to encourage all GP practices in England to join 'primary care networks' covering populations of this size. GPonline revealed at the time that plans to develop these groups were 'based partially on evidence which relied on a theory extrapolated from the size of groups of apes and monkeys'.
The additional resources called for by Dr Watson may not be financial, but could take the form of an increase in multi-skilled primary care staff to address the GP workforce crisis and promote community-based care, he said.
Speaking to GPonline, he added: ‘If we want to address the workload and the workforce issues we need to see more people working with and for general practice. That means looking at using the existing workforce more efficiently and more effectively through community teams and creating a true primary care team embedded in general practice. These teams might have GP and nurse leadership, they might include community nurses or social workers.’
He likened this to the primary care home model championed by the NAPC, which brings staff together from across the community - drawing on GP surgeries, mental health and acute trusts, social care and the voluntary sector - to focus on local population needs.
Dr Watson added: ‘We also know that there are new resources that might be needed, for example musculoskeletal services, pharmacists, paramedics… There are lots of examples where [these workers] would not only help the core locality but also help the system as a whole.’
Placing pharmacists in general practice has been shown to improve patient care and reduce GP workload, and the GP Forward View (GPFV) has pledged to support an extra 1,500 clinical pharmacists to work in general practice by 2020/21.
In addition to this, Dr Watson said hospital specialities could become more community based, which could relieve workload pressures and help bridge the gap between primary and secondary care.
‘Increasingly I think we’ll see over the next five or 10 years that some hospital specialties will be much more community based,’ Dr Watson said. ‘If you look, for example, at care of the elderly, diabetes, dermatology, etc, they could all be embedded in communities. You could also start developing the workforce by promoting portfolio-type careers whereby some GPs might want to do, say, some dermatology work alongside general practice and they can develop those skill sets [in the community].
‘If we’re going to address the workload and workforce issue we need recurrent funding to fund people to work in addition to the workforce we have now,’ he added.
Earlier this month, the RCGP demanded an £2.5bn 'major overhaul' of the GP Forward View.