Look at the skill mix
The greatest opportunity for relieving pressure on GPs is by extending and making fuller use of the wider practice team. There is considerable variation across practices with some making extensive use of a broad skill mix while others retain a traditional medical model of general practice. This is a decision for the practice – but it has clear implications for the numbers of registered patient per GP.
New roles may offer fresh ways of sharing the workload in a way that reduces pressure on GPs and improves the overall quality of care for patients. Opportunities include:
Highlighting the benefits of a broader skill mix within the practice, or potentially, across practices. Some examples are included in the case studies and appendices in this report; more may be expected to be reported from the Prime Minister’s Challenge Fund11 sites.
Providing increased funding for practices to employ members of the practice clinical team, whether this is traditional roles such as practice nurses or nurse practitioners, or new roles such practice pharmacist or GP assistant.
New ways of working are explicitly promoted in the Five Year Forward View and practices are already looking at how they can federate or find other models that offer to remove some bureaucracy (See case study: efficient rostering across a federation). In a number of areas, practices are now being managed by acute or community trusts (see case studies: community trust takes over general practice and new ways of managing general practice).
Efficient rostering across a federation: Network Locum
Agency Fees are a problem throughout the NHS – no less for Primary Care providers than for other parts of the system. Network Locum have been connecting Providers and GPs directly with each other using technology since they were founded. A relative new comer to the locum market, they provide a web-enabled staffing solution set up by GPs for GPs. Its aims are to reduce the agency fees paid by practices, reduce the bureaucracy involved in paying locums, provide continuity for practices by helping them use regular, trusted locums and improve the experience of locum GPs.
Network Locum had an existing relationship with practices in Southwark and when they were approached to support one of the GP Federations with staffing to provide extended hours services from one site their solution improved visibility and helped match the rota to local GP’s calendars. This innovation fitted exactly with the vision of the federation and commissioner in engaging local GPs to deliver additional levels of access to Southwark patients seven days a week, 8am to 8pm.
Network Locum’s CEO Melissa Morris, a former NHS manager, explains the approach. She started by setting out with the seven-day service manager the shifts that needed filling in the six months from June to December. “We provided a free tool that allowed the provider to build an on-line ‘bank’ of local GPs. When GPs from the practices who were interested in working in the extended hours project were asked about their availability 80% of the slots up to December were filled almost immediately with local doctors.” No agency fees were payable in respect of the local doctors, although Network Locum charged a fee for each out of borough placement and the federation were able to vet GPs before allocating them slots. When it comes to payment, all this is done automatically. The system generates the invoices and the NHS pension contribution form, dramatically reducing paperwork for practices.
Network Locum is already working with 1,000 practices and some NHS acute trusts who use GP locums to run urgent care centres. https://networklocum.com/about/
Community trust takes over general practice
In February 2015, Derbyshire Community Health Services NHS Foundation Trust took over the running of Creswell and Langwith Medical Practice on a caretaker basis with just one day’s notice.
A combination of factors including failure to attract staff to the practice, which serves a former mining community, led to a crisis that threatened to close the practice doors at short notice.
So Hardwick CCG called in the community provider to make sure that didn’t happen. It’s been so successful that the trust is continuing to run the practice and will now oversee its transformation into one of a new breed of multi-specialty primary care providers, offering patients direct access to advanced nurse practitioners, musculoskeletal physiotherapy and an in-house pharmacist.
William Jones, an executive director at Derbyshire Community Health Services NHS Foundation Trust, says there are many benefits to the arrangement. The trust has provided stability, clinical leadership, infrastructure, investment, a vision for the future and aligned primary and community care both for patients and clinicians.
Dr Bola Owolabi, clinical director for the north of the county with Derbyshire Community Health Services NHS Foundation Trust, says: “Having the backing of the community trust’s organisational structure means that GPs can focus on patient care as the business aspects of the practice are taken care of. A big attraction has been the innovative multi-specialist team approach and offering a portfolio career with opportunities across DCHS’ other services, such as sexual health, musculoskeletal services, geriatric medicine, rehabilitation and endoscopy via the planned care services provided at Ilkeston Community Hospital’s diagnostic and treatment centre.”
New ways of managing general practice
Northumbria NHS Trust set up a new company to run general practices in April 2015. It is a development that has the potential both to reduce bureaucracy and improve the primary-secondary care interface.
The development came about after a number of practices approached the trust for help with back office functions such as pay roll, HR and premises. It already runs two practices with a third about to join. The GPs are salaried.
Already working practices are changing, with clinical pharmacists from the acute trust now working alongside GPs in general practices.
Jane Weatherstone, GP Clinical Director for Northumbria NHS Trust, says: “It is bringing some of the efficiencies that a large organisation has and some of the relationships that will help things run more smoothly.”
The bureaucratic burden on the practices is certainly reduced because all the HR, pay roll and other administration is taken off them. However, it is too early to say whether it will cut the burden for individual GPs.
With primary and secondary care clinicians on the company board, the development also offers benefits around the primary-secondary care interface, says Dr Weatherstone. The company’s general manager has a secondary care background.
“We are starting to change some of the traditional boundaries,” says Dr Weatherstone. “We do expect to see more practices joining us and for them to start changing more of these boundaries.”