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A new five-year contract for general practice across England will see billions of extra investment for improved access to family doctors, expanded services at local practices and longer appointments for patients who need them.
The deal – the biggest reform to GP services in fifteen years – was approved by NHS England yesterday. NHS England chief executive Simon Stevens said it is the first major pillar implementing the NHS Long Term Plan, coming just three weeks after the Plan was published.
The new contract has been welcomed by NHS leaders in Cheshire & Merseyside, who said it would accelerate work already underway to sustain and transform primary care.
The extra investment will increase the numbers of clinical staff working in general practice and look to increase the numbers of pharmacists, physiotherapists, paramedics, physician associates and social prescribing support workers in general practice. The contract will also see neighbouring practices working together as primary care networks, with multi-disciplinary teams working alongside other community services.
Anthony Leo, Director of Commissioning, NHS England (Cheshire & Merseyside) and Senior Responsible Officer for Primary Care at Cheshire & Merseyside Health & Care Partnership said: “This is fantastic news and a welcome boost that will accelerate our programmes of work to support, sustain and transform primary care.
“One of our key priorities is to grow, both the number and the different types of clinicians in the general practice workforce to meet current and future needs of patients, and in addition to our work to recruit and retain GPs we have already committed additional local investments to support increases in the wider clinical workforce including nurses, pharmacists, physicians’ associates and paramedics working in practices across Cheshire and Merseyside.
“Our work to develop primary care networks is already moving at pace, with 96% of our practices already in networks and we will continue to work closely with our local clinical commissioning groups and practices to support and progress this.”
The NHS in Cheshire and Merseyside is investing £6 million over the next two years to support the development of primary care networks. In total more than 60 local primary care networks have been established with the aim of having primary care networks in place for the entire population by June 2019.
Other work already underway includes:
- NHS England (Cheshire & Merseyside) is putting an additional £180,000 investment, alongside Health Education England funding, to support practices to employ physician associates and embed their roles in general practice. The aim is to have at least an additional 30 physician associates working in general practice by April 2019.
- Working with training practices in Wirral to pilot rotating trainee physician associates and hospital doctors (foundation year 2 (F2)) so that each get a mix of primary and secondary care experience.
- Early in development are plans to implement a rotating paramedic scheme in Sefton and Halton, with the overall aim to enable more paramedics to work in primary care.
- Plans to substantially increase the number of clinical pharmacists working in general practice.There are 75 clinical pharmacists currently working in general practice across Cheshire and Merseyside.NHS South Sefton and NHS Southport & Formby Clinical Commissioning Groups have 100% clinical pharmacist coverage in their area.
Case studies – Practices of the future
Middlewood group of practices, Eastern Cheshire
Schoolhouse Surgery in Disley, Eastern Cheshire, is part of the Middlewood group of practices serving just over 32,000 patients. After seeing a rise in demand for their services, the practices are joining together to become part of the emerging primary care network. The network is looking at how they could change the way they deliver care for their community to ensure they could offer a flexible and versatile service to patients. They work very closely with health and social care colleagues from other NHS organisations and Cheshire East Council.
Working collaboratively has allowed the network to employ staff, like pharmacists and physiotherapists who work across all four practices seeing patients which in turn frees up GP time to see those patients with the most urgent need. They include a physician associate (PA) – a new healthcare role in general practice in England – who can work alongside GPs and the wider medical team to diagnose and treat patients. PA Alex Facey joined the network in March 2018 and works alongside doctors to support patients. He performs many different roles across the practices, including regular care home visits, providing proactive care to residents to help reduce hospital admissions, seeing urgent cases in the GP surgery and doing home visits. All roles help to free up GP time to see other patients.
Dr Andrew Maurice, GP Partner at the Schoolhouse Surgery and member of the Middlewood group of practices, said: “Working together through a primary care network will allow us the freedom and versatility to offer more services for our local population and is encouraging and motivating primary care in our area.
“Working in a multi-disciplinary team of doctors, nurses, social care workers, pharmacists and physician associates has brought more optimism to our practices and in the future, will allow us to care for our patients closer to home, offering continuity and personalised care.”
A video explaining the work of Middlewood group of practice can be viewed here: https://youtu.be/E-S5As686E4.
Find about more about the work of physician associate Alex Facey in this video clip –https://youtu.be/RdVstRbC_EA.
Springfields Medical Centre, Warrington
The changes introduced by Springfields Medical Centre in Warrington – including employing a clinical pharmacist and upskilling staff into specialist new roles to manage prescribing and patient care – are increasingly seen as the way forward for general practice.
Innovative new roles created by Springfields, and other practices, mean that patient journeys are now even quicker, patients have more dedicated services and GP time has been freed up to see patients with more complex needs and offer longer appointment slots when patients need them.
New roles such as GP Assistant and Healthcare Assistant deal with the practice admin and paperwork and take on some clinical duties such as taking bloods, giving vaccinations and blood pressure readings. They also help manage regular clinics such as diabetes and smoking cessation.
A clinical pharmacist reviews patient prescriptions and monitors medication for those on long-term conditions – a role previously carried out by GPs.
The practice also promotes Patient Online – more than one-third of its patients are registered for online services, including booking appointments and ordering repeat prescriptions – and, in line with the GP Forward View, offers evening and weekend appointments.
Springfields Practice Manager, Lorraine Stratulis, said: “By creating these new roles we have improved the care that our patients receive and have maximised staff retention by helping our team to achieve career goals and move forward with their employment in the medical profession”.
The changes have also enabled Assistant Practice Manager, Judith Southart to take on a new role of Care Co-ordinator, providing a new dedicated service to patients with end of life and palliative care. She oversees their medication and treatment, as well as offering daily support for patients and their families.
Dr Flora Kyriakou, GP at Springfields Medical Practice, said “The role of a GP is greatly under pressure due to increasing paperwork and patient needs. These new roles have helped a lot in our practice and I now feel able to concentrate my time on patient appointments and the care of those in need”.
Find out more about the work at Springfields here: https://youtu.be/vzUnKmhDBO4