The general practice workforce is being expanded in Lancashire and South Cumbria 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 (Lancashire and South Cumbria) is working with Health Education England, local Clinical Commissioning Groups (CCG’s) and general practices to grow the primary care workforce. In 2016/17 £14.7 million was invested in in general practice in Lancashire and South Cumbria and t £11 million has already been spent this year on a range of initiatives that include schemes to support and increase the general practice workforce.

Dr Malcolm Ridgway, Senior Responsible Officer for Primary Care for the Lancashire and South Cumbria Sustainability and Transformation Partnership (STP) said “We need a strong primary care workforce to help us to continue to face the challenges experienced by practices on the coal face of our NHS both locally and nationally.

“These additional roles are the future for people who need support from primary care and are part of the much needed transformation of primary care to improve access and quality for patients. 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 18 clinical pharmacists and six senior clinical pharmacists working across Lancashire and South Cumbria to include Blackburn with Darwen, Morecambe Bay, Fylde and Wyre, East Lancashire and West Lancashire. This number will increase as the programme continues to roll out. 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 37 students from University of Central Lancashire’s Whitehaven and Preston sites, have already completed placements in Lancashire and South Cumbria practices.

Physician associates have an increasing role to play in primary care as part of a multi-skilled workforce, alongside pharmacists and advanced nurse practitioners.  Whereas practice nurses traditionally specialise, physician associates are generalists; medically trained across a wide range of conditions. This means they can diagnose and treat children and adults with a range of clinical problems.

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.

The GP assistant gets involved with many elements of a doctor’s day to day work, both administrative and clinical.  They help the GP liaise with outside agencies, for example getting an on call doctor on the phone to ask advice or arrange hospital admissions while the GP can continue with other consultations.  Supporting the GP with immunisations, wound care and helping to explain treatment procedures to patients including arranging follow up appointments are also key parts of the role.

Paramedic practitioner

Paramedic practitioners are working within general practice to help alleviate pressure on GPs and the wider practice team.  Coming from an acute setting, the practitioners are well placed to deal with minor, short term health conditions.  The role is helping to improve access, by freeing up GP time which is leading to more clinical appointments being available.

Hear from a paramedic practitioner and patient at Adelaide Street Surgery, Blackpool:

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.