Mid and South Essex: Safe staffing in general practice

Case study summary

This case study looks at how primary care colleagues in mid Essex CCG and Mid and South Essex STP have addressed some of the common challenges of limited GP resource and safe staffing by creating an alternative staffing pool within a typical primary care setting. It explores how they have used an evidence-based model, which shares workload across a mixed group of health professionals, to accurately plan so they can remain resilient for the future. Tools such as this one demonstrate how diversification of the workforce can be planned for and may be a helpful solution to the challenges ahead.


Primary care colleagues in Mid and South Essex recognised that GPs in the area were under resourced, under pressure, and struggling with local demand. There was a limited resource of qualified GPs, which meant that maintaining a safe and sustainable service for the local population was becoming difficult.  To address the concern, primary care clinicians across the patch came together to start exploring new ways of working that would better support GPs and provide a more resilient service.

They took an evidence based approach to create an alternative staffing pool within a typical primary care setting. The aim of the approach was to estimate the likely case mix of attendances in primary care, and then secure an estimation of alternative staff needed to deliver against that need. Data collected from a network of 37 practices on reported morbidity problems was interpreted by a number of health professionals who captured the proportion of cases that could only be seen by a GP, and the proportion that could be seen by other appropriately qualified professionals. It was estimated that 37% of appointments require a GP with 63% potentially deliverable via another appropriately skilled member of the primary care workforce.

Tested against a registered population of 41,800 across Canvey Island, a GP only model of delivery estimates a requirement of 43.5 WTE GPs to deliver care safely according to LMC estimates. This suggests a significant deficit against Canvey Island’s current WTE of 28. Even if funding were available, there are not enough qualified GPs in the area to staff this model, highlighting the opportunities that could be gained by developing an alternative staffing pool. When mapping out the assumed demand of appointments per week in terms of GP only appointments, it could be suggested that the new staffing model results in a minimal GP deficit of 0.4 WTE – a clearly addressable deficit within the current GP recruitment crisis. The GP to patient ration increases to 1:2600 under this new model, compared to the national average of 1:1700. The model further predicted that 2,633 appointments would need to be distributed across other professionals within Primary Care.

When considering the availability of an alternative primary care workforce, clinical leads broadly defined four key skill mix categories that would be required to deliver the estimated 2,633 appointments – Medical, Physical, Mental, and Social. Clinical leads also estimated the distribution of these additional appointments across the four domains, with Medical taking on 30%, Physical taking on 32%, Mental taking on 24%, and Social taking on 14%. Following on from this, it is possible to estimate the number of WTEs required to deliver the additional 2,633 appointments. For example, the workforce model for the population of Canvey Island would be made up of 40 WTE – 16 GPs and 24 other healthcare professionals. This is based on the productivity of the workforce being 110 appointments per week at the rate of 20minute appointments for 7.5 hours five days a week.

This model is being used in Mid Essex CCG and the Mid and South Essex STP. Overall the response so far has been positive and staff have seen an improvement in the care they are able to give to their patients. Models such as this can allow for a shorter pathway, meaning patients have fewer appointments to attend, and with simpler logistics, patients are less likely to miss appointments or suffer administrative errors. This model could also provide longer appointment times, meaning patients feel listened to, cared for and reassured. Staff will likely see benefits in the release of GP time through the re-allocation of appointments, a reduction in prescription costs, in-house expertise gained, and an increase in clinical leadership and service development capacity.

This model was designed by Dan Doherty, Director of Transformation. To find out more, please contact: danieldoherty@nhs.net

For more information on how NHS organisations and local councils are coming together across the country to improve health and care for patients visit www.england.nhs.uk/integratedcare.