The Buurtzorg model will integrate health and social care in a highly rural area where we struggle to find carers, and staff spend much of their time in cars driving along rural lanes from patient to patient.
Having care delivered by highly qualified nurses has been shown to improve the experience of care for patients and reduce overall spend on care. Interestingly, it also improves job satisfaction for staff.
I found myself thinking about the staff aspect. It seems that the staff in the Netherlands feel they do a more enjoyable job, providing more holistic care to patients rather than simply delivering the ’nursing role.’
Can this work for GPs as well as nurses?
Maybe there are lessons we might usefully apply to other areas of the NHS? Why do people not want to be GPs or community nurses?
Is it that as we skill-mix roles to squeeze the most cost effectiveness out of the system, we inadvertently design roles that no one wants to fulfil? Does working at the top end of your competency make the role too stressful and difficult to sustain into the longer term?
When I was a young GP I did my vocational training in a rural practice in Derbyshire. The practice fulfilled a wide role in the community, we regularly visited elderly isolated patients, delivering not just their medicines but provided an important social focal point and even delivered their groceries if necessary.
Those long-gone regular visits allowed us to help sustain people in their own homes, working with the glue of the local community to support and cherish those frail people. We would now have been called their care co-ordinator.
When I first came to Catterick we syringed ears, took blood, did all our own on-call work. I remember examining a little boy with ear ache on Christmas day in our living room. We knew our patients. Was that time wasted?
Does skill-mix make roles less attractive?
Certainly they were roles that could be and are now fulfilled by other people with different training and who cost less than a GP. But did we lose something along the way?
I remember a patient who I saw occasionally over the years for relatively minor things, all of which could have been delivered by someone else. But then one day she came to confide that her husband who had dementia had been assaulting her. She had told no one. She was a retired officer’s wife - she didn’t complain. She told me I was the only person she could tell because she knew and trusted me.
I very much treasure those memories and that way of working. I worked long hours on-call every other night and every other weekend but it felt good. Now the job is much more challenging - fewer hours of highly intensive work. Is the ’decision density’ of the modern GP role just too much to sustain for 30 years?
Our CCG has the best patient satisfaction for general practice of all CCGs nationally. People often ask me why. The GPs here still provide care from predominantly medically led, small practices where personal continuity of care is still alive and well. It is changing, as it is everywhere, but is it one of those things where you don’t know what you’ve got until it’s gone?
Jobs need to work on a human level
Is our rush to define roles where everyone works to the top of their pay grade, to maximise efficiency for the system, actually designing jobs that no one wants because they are not satisfying, are too stressful and do not work on a human level?
If our trial shows that this is a cost-effective nursing model which also delivers better satisfaction for both patients and staff, should we just pause a little and reflect before we rush headlong into more skill-mixed roles for primary care?
- Dr Pleydell is a GP and healthcare commissioning lead for Hambleton, Richmondshire and Whitby CCG in Yorkshire. This article was first published on our commissioning website Inside Commissioning.
