Streeting’s latest agitprop appeared in the £walled, Sunday papers…
… the NHS workforce plan, that took four years to get through the Treasury, is to be torn up. His latest wheeze… forget all that and recruit more GPs.
There are about 6,500 GP practices, 1,300 are training practices. Expanding them will mean training the trainers and expanding the practices willing and capable of teaching. Good luck.
Parking all that for the moment… what exactly do we want to achieve by training more GPs…
… there are already, thousands we can’t afford to employ. The present plan is; grow nearly-doctors because they are quicker to get into the workforce and cheaper.
If the idea of more GPs is to get practices to do what hospitals do, here are 3 three things to consider:
Hospitals will still have to do what hospitals do, for all the people in hospital…
… diagnostics, imaging, pathology, records… and that means there will be a huge duplication in primary care… doing what hospitals do, to save people the trouble of travelling to hospital for diagnostics, imaging, pathology, records.
If we are to priorities convenience over cost and possibly quality… good luck.
Duplication means double running costs… which in part, is why the last time Labour tried this, it failed.
Second, although diagnostics are getting smaller and cheaper they still have to be put somewhere. We know half of GP surgeries are not fit for present purpose.
Expanding consulting rooms? Creating diagnostic suites? Assume there’s space on the sites: bespoke design, because every practice is different; planning consent; capital to build them, either as a loan to GP partnerships or a grant of some sort…
… which will delight the Treasury… not… and wait until next year for the funding cycle and another year and a half for design, planning, if yer lucky, a shovel in the ground.
Third, diagnostics is a skill set which has nothing to do with being a GP.
Results have to be interpreted. Although AI can screen images and test results, skilled professionals will still have to be part of the process. More GPs means more everyone else.
However… if the plan for more GPs is to stop people getting sick in the first place…
… ignoring the impediments to population health are usually; environment, jobs, education and lifestyle… 60% of first presentations of conditions are lifestyle related, let’s ask who are the most frequent users of hospital and how do we attenuate that flow?
Apart from people falling off ladders or being run over by a bus?
They are the elderly and the under 5yrs. Frailty and young families. Neither of which GPs on their own, can do much about.
Practices have frailty indexes and flag up at-risk-families but what is really needed to fix this is; better social care, community nurses and health visitors.
Long-term conditions? Take diabetes as an example. Of course, GPs are vital for diagnostics, and managing complexity but nurses, for instance, diabetes specialist nurses, can and do, manage 60-80% of routine care in stable patients.
Stepping back from Streeting’s affliction of ‘seeing a journalist and feeling obliged to say something’, and if we really wanted to look reforming and not reactionary we could move the fulcrum point of care. Make a revolution in care.
Make long-term conditions, elder and family care, nurse lead…
… there are similar models in Canada, New Zealand, Nordic countries, Australia and India. In South Africa they have an interesting STRETCH model; ‘Streamlining Tasks and Roles to Expand Treatment and Care for HIV’.
Nurses come in all career shapes and sizes, they are faster to train, dare I say, cheaper to employ and as a first-line of care for the elderly, children and long-term conditions are a lot better value for money.
And…
… they don’t require premisses. Community nurses can work from day centres, creche, community clubs, supermarkets, factories, workplaces and void shops in the high-street.
With the kind of technology routinely available, they could access records, prescribing history, the NHS App and referral to hospital and GPs as required.
If we were serious about this shift we could include a foundation module in basic prescribing as part of nurse’ core competencies … something to build on later.
We also would need to fix the bonkersness that disincentives experienced nurses from working in the community.
A Band 6 or 7 experienced nurse, in, say their early fifties can decide to retire when they’ve had enough of shift work or they could carry on and work in the community.
To do that they’d have to accept ‘de-banding’ back to Band 5, and the loss of income, whilst they are ‘re-training’.
Fiddling with policy for the benefit of headlines is OK for campaigning.
Fiddling with policy in government takes clarity, care and caution…
…if it’s to go beyond a headline.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
