PCNs need more support to recruit and integrate additional roles staff

General practice and PCNs need more support to integrate additional roles staff into multidisciplinary teams, a health policy expert has warned - and the roles may need to change to boost recruitment.

Beccy Baird, senior fellow, King's Fund
Beccy Baird, senior fellow, King's Fund

Speaking to GPonline's podcast Talking General Practice, Beccy Baird, senior fellow at health think tank the King's Fund, said that multidisciplinary teams were 'the way forward for general practice'. But she added that GPs would need help to introduce a huge shift in how primary care works and suggested that integrated care systems (ICSs) may need to take a 'system-wide' view on how the roles could be best deployed in some areas.

Ms Baird has recently completed a major study on the implementation of the additional roles reimbursement scheme (ARRS), one of the key streams of funding for primary care networks, which is due to be published by the King's Fund at the end of February.

She said: 'I think multidisciplinary team working is absolutely the way forward for general practice. But building effective multidisciplinary teams is complicated, even within a practice, it requires a shift in the way GPs work.

'This is a huge change programme - and a huge change programme needing to be implemented with very, very little external support. It's really important that we don't just let general practice struggle by itself and that systems can wrap around general practice [to help].'

Talking General Practice podcast
Listen to the interview with Beccy Baird in our podcast here. Or search for 'Talking General Practice' on your podcast platform.

Availability of staff

GPonline has reported on concerns that the ARRS will fail to recruit the extra 26,000 staff promised by the end of 2023/24. Earlier this month the RCGP warned that progress towards hitting the target was 'slow and very concerning'.

Analysis by GPonline suggests that nationwide, the number of FTE staff recruited by PCNs is around 10,750.

PCN leaders have said that a lack of time during the pandemic and a shortage of suitable staff to recruit mean they have hired fewer recruits than they would have expected at this stage and have asked for increased flexibility around the scheme.

Ms Baird suggested that the workforce was potentially available to recruit, but said her research suggested that different models might be required to meet the 26,000 target.

'Some of the roles like paramedics, physios and others, they see massive benefit in working across both acute and primary care because it helps them understand the pathways better.' Ms Baird said.

'So if you're working as a paramedic in primary care, you're probably working mainly with older people, really understanding what it means to keep somebody at home. And that really helps you when you're out in the ambulances. And actually, most paramedics that I spoke to still work on the ambulances, because they keep up their skill, so they are either on a rotational roll or split roll. It's the same with physiotherapy.'

But, she added, it required 'a more systematic and a system-wide view about how you deploy these roles' to make such schemes work. 'I think potentially there are those staff out there. It's about making best use of those roles across the system.'

Support for general practice

Integrated care systems also needed to look at what could be put in place to 'support general practice to be the best it can be', Ms Baird said.

'Additional roles have the potential to be absolutely brilliant, but I'm not sure that we've got all the right ingredients in place right now for that to happen,' Ms Baird said.

'My view based on my research that we've done that the King's Fund is we're not making the best of these new roles, because it's really hard to implement new roles. And that needs supporting, it needs headspace and time. And if we haven't got the GPs to provide that headspace and time, what are the support is there out there that can help to do some of this work?

'If you're putting new roles into an NHS trust, there'd be an HR department, there'd be an organisational development department, there'd be all kinds of change management programmes going on in NHS trusts. That does not exist in general practice. And if it does exist, it's patchy.'

Primary care estate

Ms Baird also highlighed that ICSs would need to address problems with the primary care estate if the ARRS was to succeed.

'This is not just about having extra staff sitting in extra rooms, doing extra clinics, this is about a new way of working. Our estate doesn't lend itself to this kind of working well. Most practices are all individual consulting rooms. Actually, for really successful multidisciplinary team working you probably need shared team space, and then use the consulting rooms differently,' she explained

'Trying to redevelop the estate is very difficult,' she added. 'But thinking about primary care as part of a wider ICS estate strategy [is] really important.'

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