The RCGP’s annual conference last week saw fresh warnings about the pressures faced by GPs. Meanwhile, we’re reaching the time of year where the now traditional warnings are made about a forthcoming winter crisis.
Calls to combat these threats tend to focus on more GPs and more money. Since the former will need a few years, and the latter a complete change in tack from the Treasury, it is little wonder that different models of delivering primary care are being looked at for the immediate future.
The BMA’s recent report on general practice, ‘Responsive, safe and sustainable’, called for a broader team of professionals to be available to patients, a point echoed recently by MP and health select committee member Rachael Maskell.
‘I think we need to ask what does a GP do,' she said. ‘Because the role has evolved so that GPs do so many things now, and actually with advanced practitioners and other professionals being part of the equation and social mix including new care coordinators, is there a better triaging system to ensure GPs can do what GPs do best.’
That simple theme – freeing up GPs to do what they do best – speaks to the larger truth about how we can improve patient care.
A recent report by the NHS Alliance and the Primary Care Foundation found that up to 27% of GP appointments could be avoided through better co-ordination between practices and hospitals and through better use of skill mix and technology.
Skill-mix in primary care
We need to recognise that a number of professions, from GPs and nurses, to physios, paramedics and pharmacists, have their own skills, strengths and contribution to make and offer patients them all as a first point of contact so that they see the right person at the right time.
Through this, we can create a system that is built around the needs of patients instead of traditional roles and structures and save significant amounts of time and money.
This is already happening in many surgeries across the country, of course, and we highlight some excellent examples in a new briefing.
At Windermere Health Centre, in the Lake District, a physiotherapist joined the practice team to assess, diagnose and triage MSK patients, who can comprise up to 30% a GP’s caseload.
During the first three months, 168 GP appointments were freed up and the translation of orthopaedic referral to operation rate increased to 99%.
Additionally, the number of steroid injections delivered in the centre rose because the physiotherapist could also do this, generating income for the practice.
In Betsi Cadwaladr, north Wales, two physiotherapists worked across four practices and in the first six months, saw 1525 patients who would normally have seen the GP. Only 23 of these patients required any input from the GP and there was a 12% reduction in secondary care referrals.
Physiotherapists in primary care
The potential here, for patients, primary care and the public purse, is enormous.
In addition to the MSK cases, physios could be seeing patients with respiratory problems, continence issues and frailty, to give three examples. They are also the experts in movement so have a big role to play in public health and raising physical activity levels.
Let me be clear - this isn’t about role replacement; it’s about broadening the skills mix in primary care to meet patient need and ease the massive pressures in that sector. The skills of physiotherapists would complement those of their GP colleagues, and the nurses, and the pharmacists, and the paramedics.
Sometimes it takes a bad situation to force a change for the better. Primary care faces surging demand at a time of budgetary restraint and a shortage of GPs. Either it evolves or something has to give.
Widening the offer to patients at their first point of contact would represent a step towards a new model of delivery that could radically transform not only primary care, but the NHS as a whole.
- Professor Karen Middleton is chief executive, Chartered Society of Physiotherapy