12 • Analysis
INNOVATION ASPIRATION
A new report on the future of primary care imagines greater use of technology and GPs assisted by new types of healthcare professional
& T
HERE have been numerous reports in recent years looking ahead to how future UK general practice will operate. These tend to contain lists of practical predictions and
recommendations based on current trends, combined with more aspirational elements of how primary care at its best would work. Common themes include more efficient use
of technology, longer consultation times, increased funding, and multidisciplinary team working.
The Primary Care Workforce Commission
(PCWC) is the latest to share its vision in its new report The future of primary care – creating teams for tomorrow, commissioned by Health Education England. Its stated aim is to identify solutions to
meet “present and future needs of the NHS” as it faces “increasing and unprecedented pressures”. It follows a similar report published by the Royal College of GPs in 2013, A Vision for General Practice in the future NHS. One key consideration in the PCWC report is
the way that increasing patient demand has combined with drops in both investment and GP numbers to create major workload issues within primary care. An RCGP poll in June 2014 found that more than 80 per cent of GPs worried about missing a serious condition in a patient because of their heavy workload.
New team members To address such pressures, the PCWC presents one of its boldest ideas – for practices to employ other health professionals to ease
the work burden. This could mean (upon completion of successful pilot schemes) administrative staff such as medical assistants taking over large portions of practice paperwork. GPs spend as much as 11 per cent of their time on administrative tasks, the report states, and if this work was taken on by the likes of medical assistants it would be the equivalent of 1,400 more full-time GPs in England.
Under the plan, wider use would be made of
physician associates and healthcare assistants; prescribing pharmacists would help manage people on long-term medication; and paramedics would substitute for GPs in the assessment of urgent requests for home visits. The proposal has been given a broadly
positive reception by the RCGP. Chair Dr Maureen Baker said the College welcomed “any suggestions that will help to ease the unprecedented pressures on GPs and help us to deliver the care our patients need.” She went on: “We would be interested in
having community paramedics as part of practice teams”. But she emphasised that services provided by additional health staff “must not replace the GP appointment – and paramedics must never be used as a substitute for GPs.”
Falling numbers While these additional staff may indeed help ease practice workload, they would still have to work under GP supervision. The PCWC report acknowledges this, stating: “Unlike the US, physician associates in the UK need authorisation from a doctor when they judge
that a patient needs a prescription. Working under the supervision of a GP, they can make a significant contribution to practice workload.” It adds: “While we recognise considerable
potential in developing these new roles, the governance of these new staff members will be of critical importance in ensuring the quality and safety of their work.” This again raises the issue of recruitment and the question of whether there would be sufficient GP numbers to provide supervision. In her response to the report, Dr Baker reiterated the College’s call for 8,000 more GPs in England to meet increasing demand, but conceded this would take time and that “thousands more GPs could not be delivered overnight even if the funding was in place.” While the report does not address GP shortages in great detail, it does highlight the rather stark fact that between 2003 and 2013 the number of hospital consultants has increased by 48 per cent while GP numbers rose by only 14 per cent. GPs per head of population, it adds, has declined since 2009 “with major problems of recruitment and
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