CCGs urged to address GP shortage

1 November 2012
Despite the influx of new doctors over the last decade, the NHS workforce has been facing its own demographic crunch for years.
 
At the turn of the century 14% of GPs were aged over 55 – that figure now stands at 22%. Some 10,000 have said they intend to retire over the next five years.
 
One in five practice nurses are 55 or over, limiting the extent to which the continuing expansion of the role of the practice nurse can fill the gap.
 
The General Medical Council’s (GMC) annual state-of-the-profession update, which was published last month, highlighted other factors that have implications for primary care workforce planning.
 
The State of Medical Education and Practice in the UK (2012) confirmed that last year the number of women doctors on the register passed 100,000 for the first time. The GMC predicts that at some point in the next decade registered women doctors will outnumber their male counterparts. The growing number of women doctors may offset the problem to some extent, but this group is also more likely to work part-time and some may also take maternity leave at some point.
 
Jill Matthews, deputy director of commissioning development with NHS Midlands and East, argues that clinical commissioning groups (CCGs) should be “doing a PR job” promoting the advantages of a primary care career both to teenage pupils and medical and nursing students.
 
“Promoting the benefits of a career in primary care is something that CCGs together with local education and training boards can legitimately be getting involved in. They also need to be looking at things like the numbers of nurses in training because the decline is a risk. We all have a part to play,” she said.
 
Back at the other end of the demographic career path, however, the pressures could be exacerbated by an unfortunate coincidence in timing of unrelated events. The requirement for GP validation, practice registration, falling average GP income and the GP pension changes are thought likely to increase the exodus from the medical register. Pressure on some practices is also likely to increase if one or more of their GPs play an active role in commissioning.
 
Matthews says that CCGs and practices will have to make difficult choices between improving quality (one measure of which is longer appointment times), access (longer opening hours) and the availability of clinical leadership.
 
“CCGs and local area teams are going to have to work with practices to come up with the best answer locally.” Her cluster has developed a series of initiatives to relieve the strain in primary care (see box) which includes recognising the potential role of community pharmacy.
 
“We all need to see community pharmacists as partners in clinical care as opposed to dispensers of medicines. If the CCG works closely with pharmacies and practices we can look at greater access to high quality clinical advice through the local pharmacy that is always going to be open longer hours.”
 
That view is shared by Stephen Foster, a pharmacist who leads the Healthcare Professionals’ Commissioning Network and whose recent appointment to the executive of the National Association of Primary Care could itself be significant. He is the first appointee from outside general practice.
 
Foster says that at a national level GP leaders are increasingly recognising that while GPs might do most of the diagnosing, the management of long term conditions in future should largely be done by other professionals in the community. He also points to the requirement in domain 1 of the CCG authorisation process that CCGs must be able to show “widespread involvement of other clinical colleagues providing health services locally”.
 
Foster emphasises that community pharmacy and GP practices can work in a complementary rather than competitive manner on initiatives such as vaccinations and the new NHS health checks.
 
“Only 30% of patients on a practice’s register see their GP during the year so that leaves 70% of patients who will get health advice from pharmacists, opticians or dentists. Also, my pharmacy is open 100 hours a week which is never going to happen with a GP practice.”
 
Pointing to research showing health professionals who train together work in a complementary fashion, Foster says that once CCGs have formal control of most local health spending they will have to embrace community pharmacy. Faced with declining margins on prescriptions, pharmacists will prove willing partners in offering new health services and relieving the burden on a declining GP workforce.
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