Future Of Primary Care Creating Teams for Tomorrow
Original Document The Future of Primary Care Creating teams for Tomorrow
A report by the Primary Care Workforce Commission. July 2015.
This document has been received by Health Education England which “will now look closely the  recommendations...” it contains.
There is the by now usual exposition of the problems faced by primary care – increasing workload, ageing populations, more complex conditions being looked after in the community, recruitment and retention, poor premises and the changes in relationships between the public and professionals - together with traditional (if welcome) expressions of appreciation of what it achieves under difficult circumstances. There is a welcome reiteration of the gap in investment that has opened between primary and secondary care with consultant numbers increasing by nearly a half between 2003-13 whilst GP numbers expanded by a mere 14% representing an actual reduction per head of population since 2009.
The commission says that, despite all this, it has formed “a vision of primary care that will provide challenging and fulfilling careers for health professionals whilst delivering a standard of care…of which the NHS can be truly proud.” It can do this, moreover, by commending ideas and schemes already happening somewhere in the NHS.
Inevitably primary care must change but still remain based on practices with expanded workforces and a “stronger population focus” holding responsibility for registered lists. Patients will be seen more often by new types of healthcare professional such as physician associates and clinical staff will have better administrative support allowing longer consultations with patients, to allow better care planning (that mainstay of modern managerial hopes) and communication will be more likely to be by e-technology. There will be more integration through networks and federations, primary, community, secondary and social care teams will work together more closely using shared IT and premises will be upgraded to make better use of community facilities. All this will start in areas with the greatest needs and inequalities. Education and continuing support will be needed to help primary care staff including managers to provide the leadership that all this will require.
The first recommendation is that the Ten Point Plan agreed by HEE, NHSE, the RCGP and BMA in 2015 be implemented rapidly along with the government’s commitment to recruit “5000 more GPs” although there is no mention of the Health Secretary’s subsequent admission that this target was “flexible.” There is also a welcome recommendation that a national drive be recreated to monitor GP numbers and so govern recruitment and training, something which the King’s Fund recently commended as being useful in the case of health visitors. The pendulum is clearly swinging back to central, rather than local or regional responsibility in workforce planning.
The second recommendation is like the first but concerns primary care nursing which the report argues requires its own Ten Point Plan. The third is that community pharmacists should be involved in the medicines management of patients with long term conditions and in care homes but should be based in practices to ensure good communication with GPs and full access to medical records. The fourth is that old familiar plea for pharmacists to be more involved in managing minor illnesses with agreed protocols between them and local practices for treatment and referral back to primary care. The fifth is that more physician associates and health care assistants be employed and the old concept of paramedics substituting for GPs on urgent home visits still “merits further evaluation.” Community nursing needs to be available 24 hours a day in all areas to achieve the long sought significant and sustainable shift of care out of hospitals. Research into the cost-effectiveness of using a “relatively unskilled workforce” to triage OOH care is urged as it “may be a cause of hospital overuse.” Finally, in the workforce section, practices should analyse their clinical case-mix and agree criteria for what each professional will actually do and, as an encore, provide contracted protected time to support effective team working. The need to work “at scale” has never been better expressed as even quite large partnerships will find this challenging. Furthermore, in the quality and safety section practices are encouraged to allow for longer consultations allowing those with complex long term conditions to see a clinician that they know and the ability to do this “should be a key metric of the quality of general practice care.” Data in this field should be publicly available with a priority to develop measures of integration.
This is a worthy document but does read rather as a “wish list.” How influential HEE will prove to be in changing the course of government policy, which seems all too often to will the ends but not the means to achieve what is desirable, remains to be seen.
Dr Barry Moyse
LMC Deputy Medical Director