Growing multidisciplinary teams in primary care

Being an ‘expert generalist’ as a GP is something I take great satisfaction in. I love the process of diagnosis – listening to my patients as they present at the front-door of the NHS and understanding the challenges they’re facing, then working with them to investigate their cause and define the most appropriate course of support or treatment.

In 2019 we were given the green light to recruit to new roles through the additional roles reimbursement scheme (ARRS). This was designed to complement the existing general practice team and help to manage increasing demand and complexity of medical and social issues.

As the multidisciplinary team in my Primary Care Network (PCN) grew, I quickly realised it would sometimes be better for more specialised clinicians to provide that initial service: better that a patient on a large range of medications sees a pharmacist for their medication review, those presenting with musculoskeletal issues are dealt with by a physiotherapist and someone struggling with their mental or social health is supported by staff specifically trained to help.

Some of the 17 additional roles, like physiotherapists, directly substitute activity traditionally provided by GPs; others, like general practice assistants, are intended to help GPs focus on tasks only they can deliver by freeing them up from administrative work. What inspires me most though are the countless examples of the expanded team supplementing traditional general practice to bring an even greater focus on wellbeing, proactive care and keeping people well at home and in the community.

It’s no surprise that PCNs have taken the opportunity to expand their skill set to meet the health needs of their patients. In the year the NHS turns 75, exceeding the target of recruiting 26,000 additional patient facing staff a year ahead of schedule is an achievement primary care colleagues across the country should be truly proud of. Put simply and as a rough average, this means 20 new staff members across an average PCN, or four per practice. As a clinician though, I find myself reflecting less on targets, and more on what those new members of staff mean to patients in my PCN, and across the country.

A clear benefit of expanding capacity in general practice has been an improvement in patient access, ensuring patients are seen quickly by the right health professional for their needs.

That’s not to say this has been easy. These new teams were hired while networks themselves were finding their feet, some roles were new to the general practice setting and each new member of staff has required support to flourish in their role. This scale of transformation would be impressive at the best of times; the fact it has been delivered through a global pandemic is astounding. It is a testament to the responsiveness, resilience and drive of general practice, and reinforces the value we continue to offer to the NHS as a whole.

Looking to the future

I know we have more to do to support our new teams. We must help patients and clinicians understand what these new (and sometimes unfamiliar) roles can deliver, and better explain why it is not always best to see a GP. We need to help staff transition into general practice and support each and every individual recruited to build long and fulfilling primary care careers.

More fundamentally, we also need to continue to adapt to one of our new roles as GPs – that of leaders and managers of larger, more diverse, highly skilled teams who are increasingly vital in our ability to provide the right care for our patients, in the right place, at the right time. Those teams are now firm fixtures in general practice: NHS England has committed to fund staff hired through the scheme beyond 2024, and PCNs should feel comfortable offering permanent contracts.

Looking to the future, and reflecting on the Fuller report vision for general practice, I am both excited by the scale of ambition, and heartened by the solid base of existing teams from which we can build. When I hear from sites like Hounslow (where staff recruited through ARRS are dissolving the boundaries of traditionally separate ‘primary’ and ‘community’ services by embedding themselves with the local community team), I see examples of how that vision can be reality, and how integrated, proactive, primary and community care can grow from words in a plan, to new services on the ground, delivering ever more improvements in care for the communities we serve.

Dr Kiren Collison

Dr Kiren Collison is a GP and Deputy Medical Director for Primary Care, NHS England.
Kiren has a focus on strengthening primary care, the interface between primary and secondary care and patient safety. She has previously worked across settings, both as provider and commissioner, and has been the chair of the NHS national long COVID taskforce.