Current situation in Sussex
In a recent study we explored the use of Allied Health Professionals to diversify and enrich the clinical teams of GP surgeries across Sussex. 163 GP surgeries have been analysed and the results are below:
% of GP Practices using specific Practitioners
|Brighton and Hove CCG||East Sussex CCG||West Sussex CCG||TOTAL SUSSEX|
|Advanced Nurse Practitioners||45.2%||51.9%||43.6%||46.6%|
Unsurprisingly, Advanced Nurse Practitioners, being the most traditional non-medic clinicians in GP Practices, are the most common Practitioners in GP Practices, with almost half of the GP Practices employing one in Sussex.
Paramedics are now more common than Clinical Pharmacists
It is interesting to see that Paramedics are now more common than Clinical Pharmacists (this is based on headcount though, not on FTE). It is also notable here that East Sussex and West Sussex have a large lead in the use of Paramedics compared to Brighton & Hove where only 3.2% of the GP Practices have Paramedics.
East Sussex and West Sussex have a large lead in the use of Paramedics compared to Brighton & Hove
Physician Associates and Physiotherapists are rather new and less used. It is notable that East and West Sussex also have the lead here compared to Brighton.
* In this study we have only included the most common additional roles, namely ANPs, Paramedics, Clinical Pharmacists, Physician Associates and Physiotherapists. Also, we have considered the workforce at a practice level, not including PCN contributions.
Benefits of diversifying clinical teams in general practice
New roles bring a host of benefits and introduce new perspectives and skillsets. But, is there a danger of simply reworking the same patients repeatedly, and of duplicating effort, rather than displacing it?
Some have likened GPs to the conductors of an orchestra of health care professionals. But the comparison with other medical settings seems more apt – with medics acting as the primary care consultant in a clinical specialist team. In this model, the GP ceases to be the first port of call, but the senior who provides support, oversight and clinical judgment to the team, whilst training and leading.
Since GPs have the longest training lead time of any professional group in General Practice, we’d therefore expect that over the next decade the losses in this professional group will take the longest to subside, and the balance of clinical teams in practices will be forced to change, with a higher ratio of AHPs and nurses to medics.
Which category of staff should I consider first for my practice? (or Specific benefits of each category of staff)
The first step is to perform a demand and capacity analysis with your practice to help identify the most relevant staff groups to consider. Key elements would include identifying non-General Practice demand (such as dental and ophthalmic issues) and redirecting them to other local providers. We would also explore the level of demand for MSK, dermatology, mental health, elderly care, urgent/acute care, and medication management processes, such as the use of Repeat Dispensing and medication review protocols. Many practices find that there is work which they are doing that is either unpaid, or underfunded for the capacity being delivered, and identify opportunities to renegotiate with commissioners. Significant funding and capacity can be released in this way, through careful detailed analysis of activity, payments, and staffing.
There is no one-size-fits-all solution for clinical staffing for practices, as every practice has variations in demographic factors that influence demand. A practice with a high elderly population might consider jointly employing a matron with the community nursing service with care of the elderly in mind. A practice with high numbers of young families might consider a paediatric nurse specialist, or a university practice might consider partnering with mental health and Genitourinary Medicine (GUM) teams to deliver novel and creative new models of care.
Just as relevantly, there is no blanket description for the role a professional group can bring to a practice. The variation in specialties, training, experience and interest in staff is just as varied amongst AHPs as it is amongst GPwSIs. The key is to understand in detail the data behind what the practice really needs, and to match this with the right professional for your team.
As ever, the availability of key clinical staff is the major deciding factor. At the time the NHS People Plan was published, pharmacists were the only UK registered healthcare professional workforce in surplus. Since then, that trend has been reversed by the demand for Clinical Pharmacists in practices, and so the challenge deepens further.
A key to securing the right staff is creating the right environment in the practice. Staff moving from traditional roles for their profession will undoubtedly need high levels of openness, support, training, encouragement and an atmosphere that is positive and open to the value they bring.
Practices will need to work together at scale or identify creative solutions to match or better these offers in order to attract staff away from roles where they have traditionally been employed
Many staff will come from settings such as acute and ambulance trusts where benefits such as salary sacrifice schemes for cars and a range of other household goods and services, childcare voucher schemes and direct childcare provision are a part of the overall package offer to employees. Practices will need to work together at scale or identify creative solutions to match or better these offers in order to attract staff away from roles where they have traditionally been employed.
On the plus side, many staff in trusts will have experience of shift working, and may be glad to leave the late nights and early starts behind for the relatively sociable hours of General Practice. But practices must keep one eye on the future with the evolution of the GP contract, and an increasing pressure to offer 8 til 8 opening hours from commissioners. A future of multiple shifts working shorter hours through a longer working day may yet prove to be the most effective way for practices to meet the demands of the future.