The general practice workforce is being expanded in Cheshire and Merseyside to ease pressures on GPs and make it easier for patients to get an appointment when they need one.

As well as GPs and practice nurses, practice teams are increasingly likely to include healthcare professionals such as clinical pharmacists, physician associates, paramedic practitioners, and a range of different nursing roles.

It’s all part of the General Practice Forward View (GPFV), the national programme that will see £2.4 billion invested in primary care services by 2021 to ensure they can meet the future needs of patients.

Workforce is widely recognised as a key priority for general practice, with workload increasing as demand continues to grow.

To address this, NHS England (Cheshire and Merseyside) is working with Health Education England, local Clinical Commissioning Groups (CCG’s) and general practices to expand the primary care workforce. In 2016/17, £20.4 million was invested in general practice in Cheshire and Merseyside.

Dr Craig Gillespie, Clinical Vice Chair, NHS South Sefton Clinical Commissioning Group and GPFV Programme board member, said “We need a strong primary care workforce to help us to continue to face the challenges experienced by practices on the coalface of our NHS both locally and nationally.

“These additional roles are the future for people who need support from primary care. It isn’t about restricting access to doctors, it is about using the other people within practice teams, like nurses and clinical pharmacists, who are often better placed to give advice and support.  This then frees up general practitioners to see more complex and sicker patients who really need them.”

The additional roles include:

Clinical Pharmacist

There are already 39 clinical pharmacists and 8.5 (WTE) senior clinical pharmacists working in 64 practices across Cheshire and Merseyside including Halton, Knowsley, Liverpool, South Cheshire, Vale Royal and Warrington covering a population of over 600,000 people.  This will soon extend to a further three locations in Eastern Cheshire, Wirral and West Cheshire working across 38 GP practices. An additional seven clinical pharmacists and three senior clinical pharmacists will serve a population of more than 300,000. Clinical pharmacists work as part of the surgery team to resolve day-to-day medicine issues and consult with and advise patients about their medicines directly. With training and supervision they can also consult with patients to diagnose and treat illnesses, prescribe and refer onwards as appropriate.  In other parts of the country this role has been shown to create up to 3.5 hours of additional time for GPs to see other patients each day.

Physician Associate

Physician associate (PA) is a new healthcare role that is already well established in the US and is starting to be introduced to general practice in England. A number of graduate trainees on the Health Education England programme, including 52 from Liverpool University, have already completed placements in Cheshire and Merseyside practices.

Nursing roles

General practice nursing (GPNs) teams provide care and treatment across the life course of a patient and increasingly work in partnership with people with acute illness and with complex conditions.  GPNs work with their GP colleagues, clinical pharmacists, physician associates, other allied health professionals like physiotherapists, practice managers and receptionists, as part of the extended primary care team. Roles include practice nurses, advanced nurse practitioners and nurse prescribers.  Each role is slightly different and offers their own unique levels of support to the patients they see.

GP Assistants

GP assistants (GPA), work directly with doctors to support them during consultations, including helping to perform routine tests such as a blood pressure check.

Roe Lane Medical Surgery in Southport is one of the first in Cheshire & Merseyside to employ a GP assistant.   GP, Dr Niall Leonard said, “Dealing mainly with older patients with more complex needs rightly takes more of my time. Working alongside a GP assistant helps free up some of the time I would normally have taken doing simple tests and admin work to focus solely on the patient and their needs.  This makes me more efficient and able to see more patients.”

Community Specialist Practitioner (Paramedic)

Community Specialist Practitioners (CSP) are specialist paramedics, employed by North West Ambulance Service (NWAS), who work within primary care to help alleviate pressure on emergency NWAS resources and local hospitals. Working collaboratively with local GPs, care homes and the wider allied health professional network, CSPs help to co-ordinate health and social care resources to ensure the best possible care for patients.

Eaglebridge Health and Wellbeing Centre in Crewe is the base for CSP Ewan Armitage.  Ewan works across South Cheshire to help reduce the volume of 999 calls and unplanned admissions to A&E by supporting improved triage of patients in care homes, promoting advance care planning for the most vulnerable patients, working with the End of Life partnership as well as working with the wider team of nurses and physios to coordinate support for patients. Ewan is also responsible for developing a number of alternative to transport options within South Cheshire for NWAS to utilise and also works with Cheshire East Council and community-based organisations to support patients who rely heavily on the NHS and other emergency services.

Care Navigator

Care navigators are GP practice staff who have been given specialist training to help them direct patients to the right health professional first time. When patients contact their general practice, the care navigator will identify what their query is and which healthcare professional they need to see. Far from restricting access, this is about improving access to primary care for patients and addresses concerns patients frequently report about not understanding which services are available and which to use when.