3 Strategies for a Stronger Primary Care Workforce

Introduction:

Primary care, often considered the backbone of the NHS, is facing significant challenges due to mounting pressure and a diminishing workforce. In response to this crisis, the “Fit for the Future” campaign by the Royal College of General Practitioners (RCGP) is urging patients and healthcare professionals to engage their Members of Parliament (MPs) in addressing the urgent issues plaguing general practice. Based on their data analysis, the RCGP has identified key areas that require immediate attention. These include bolstering GP infrastructure and IT deployment, implementing recruitment and retention strategies, enhancing patient access, and ensuring the GP contract remains relevant by incorporating financial adjustments based on inflation.

Decreasing Practices and Rising Patient Numbers:

Regrettably, the number of general practices where these improvements need to be made continues to decline while the number of patients seeking care continues to rise. This troubling trend stems from various factors such as practice mergers, challenges in recruiting staff, retiring GP partners, and insufficient funding for practices to sustain their operations.

The Implications of a Primary Care Crisis:

It is essential to recognise that a crisis in primary care affects everyone. Like a building’s foundation, if it is not reinforced with quality concrete, the entire structure becomes shaky. In the context of healthcare, a weak primary care system jeopardises the overall health and well-being of the population.

In this article we will explore practical strategies to address the primary care crisis and fortify the workforce.

3 Strategies to Address the General Practice Crisis

1. Establish Safe Working Limits in General Practice

The combination of staff shortages, limited budgets, and escalating patient demand has led to most GPs handling up to 40 or more consultations per day. This current workload, with short 10-minute consultations and a high number of patients, contributes to burnout among GPs. To address this issue, BMA report on “Safe Working in General Practice” proposes a recommendation that GPs making 28 patient contacts per day is safe. This will average about 140 appointments per week per GP over five days. By implementing this approach, GPs can provide better care and effectively address patient needs, relieving the burden on both doctors and patients. The primary goal is to ensure patient safety and enhance the overall quality of healthcare within GP practices.

To support this approach there needs to be community conditioning by raising public awareness on the use the service within their area, supported by robust community involvement by the primary care workforce. This can be achieved with collaboration with other healthcare providers and with community leaders, patient groups, and other stakeholders. This can take the form of community outreach programs, health promotion initiatives, and active participation in local events. Primary care professionals can shape the healthcare landscape to better serve the community’s needs and they should be incentivised to achieve this level integration in their local area. By giving voice to the people, they can advocate for the type of service they need in their locality.

2. Simplify the Establishment and Operation of NHS GP Practices in Each Postcode

While there are plans to build 40 hospitals by 2030, the declining number of general practice surgeries raises the question of whether we should focus on increasing the number of GP practices to support the primary care workforce. It is essential to support GPs in their role as family doctors and recognise their contribution as the backbone of healthcare within their respective communities, upholding the structure of the NHS. The independent contractor model should be supported and made more accessible and attainable to new entrants into the profession. Similarly, the GP contract should be flexible enough to allow participation from other health care professionals.

The closure of practices especially in deprived areas, where they are most needed, often stems from a lack of funding, which exposes a larger systemic issue. Currently, primary care receives a small percentage of the NHS budget, around 9% based on recent data. The government could explore additional funding options, such as grants or expanded reimbursements, to support the setup and operational costs of primary care practices. This would enable practitioners to focus on delivering high-quality primary care. Furthermore, incorporating relevant courses on the business aspects of primary care into medical schools and postgraduate colleges could inspire entrepreneurial-minded students to tackle the challenges of establishing and operating more GP practices wherever they find themselves.

It’s important to raise awareness about the diverse roles required in general practice and ensure that both clinical and non-clinical practitioners are fully qualified and receive necessary support from their respective governing bodies and supervisors to pursue a career in primary care. The expansion of roles in primary care allows for the inclusion of a passionate group of professionals who meet the demands of the primary care contract as it relates to their local communities. Additionally, with the introduction of primary care networks, there is increased capacity to recruit for other roles. Read more about expanded roles in Update to the GP Contract Agreement 2020/21 – 2023/24.

To contribute to the solution, individuals may engage with their local surgery and inquire about these various roles, assessing if their skills align with the needs of primary care. Could we entertain non-GP roles to offer parts of the GP contract as independent, maybe subcontracted teams? e.g., an NHS physiotherapy service dealing with acute and chronic primary care physiotherapy needs of the local population, or mental health clinics for mental health presentations. Could patients make first contact with these type of clinics to get the help and follow up they need without seeing a GP as part of spreading work across teams in primary care

3. Foster Team Building in Primary Care for a Sustainable Workforce

Building a cohesive team within primary care is crucial to ensuring a sustainable workforce. Unfortunately, many job seekers still do not perceive the general practice landscape as a welcoming sector. Poor feedback mechanisms, a lack of recognition, and feeling underpaid are prevailing issues that contribute to recruitment and retention challenges. It is essential to reignite the vision of primary care within the community and other institutions, providing practitioners with the necessary support to deliver the quality primary care they aspire to.

The NHS Healthcare Leadership Model is a framework, developed by the National Health Service (NHS) Leadership Academy, which emphasises the importance of establishing a shared vision, promoting effective communication, fostering collaboration, and creating a positive work environment. It also highlights the significance of personal qualities, such as self-awareness and resilience, in effective team building. By understanding and implementing this framework, primary care teams can navigate the stages of forming, storming, norming, and performing, fostering strong teamwork and collaboration.

Its clear that the challenges confronting primary care are complex and multifaceted. However, by empowering the establishment of more general practices, adhering to safe working limits for primary care practitioners, and cultivating a vibrant work environment that prioritises staff well-being, we can apply a cooling effect to the boiling crisis in primary care.