A series of recommendations have been set out by a major review of primary care workforce commissioned by Health Education England.

  • Major Health Education England-commissioned review into primary care workforce makes a series of recommendations for primary care workforce
  • Bidders for out-of-hours and community nursing contracts should “demonstrate that they have the ability to integrate well with other primary care providers”
  • Calls for broader primary care skill-mix, including greater use of physician associates and healthcare assistants

The report by the Primary Care Workforce Commission, published today, called for contracts for community nursing services and GP out-of-hours care to require bidders to “demonstrate that they have the ability to integrate well with other primary care providers”.

“This will encourage contracts to be held by organisations representing primary care providers, for example, federations of GP practices, multi-specialty community providers or primary and acute care systems, rather than by stand-alone providers or community trusts,” the report said.

Health secretary Jeremy Hunt in October commissioned Health Education England to conduct an area by area examination of general practice capacity, after admitting current assessments involved guesswork. The Commission was led by Martin Roland, professor of health services research at the University of Cambridge.

The report argued there would be “substantial potential benefits” from a “range of new approaches to staffing”, including greater use of new professions, such as physician associates and healthcare assistants, within GP practices. Mr Hunt promised additional 1,000 physician assistants by 2020 as part of the government’s ‘new deal’ for general practice, announced last month.

The health secretary also promised 5,000 additional GPsas part of the new deal. Today’s report warned that “national targets for GP numbers should be regularly reviewed” and there “should also be scope to adjust plans at local level providing that those plans can be demonstrated to meet local need”.

It also suggested that paramedics could substitute for GPs in assessing of urgent requests for home visits.

However, it warned the “relatively unskilled workforce” in out of hours triage “may be a cause of hospital overuse”.

“The costs and benefits of using a relatively unskilled workforce to triage requests for out-of-hours care are not sufficiently well established and may be a cause of hospital overuse, the report said.

“Research is needed to compare skilled versus less-skilled staff providing telephone triage in out-of-hours care.”

The report also argued for a much greater use of technology, including email correspondence and electronic messaging become “routine” between primary care and hospital specialists, and that email between primary care clinicians and patients should be piloted prior to becoming a routine part of NHS care.

There should be a general practice electronic record used by all primary care staff, including community nurses and health visitors, the report recommended.

It also called for data to be publicly available on the quality of primary care, including measures of access, communication, clinical quality and integration. The latter was a “priority” because “these do not currently exist in a form that can be routinely applied in the NHS”.

Among its 38 recommendations were access to a named paediatrician and a named children’s nurse in GP practices, and a named consultant psychiatrist and a named mental health worker in every practice or groups of practices.

Royal College of GPs chair Maureen Baker said the report “has the potential to be a game-changer if the Government and others take heed and act on its recommendations”.

She said the RCGP was“open to widening the skill-mix in general practice, with the introduction of roles such as practice-based pharmacists to take on some of the tasks that do not necessarily need to be done by a GP.

However, she warned: “These will never be a substitute for GPs so any new roles, such as medical assistants, must be properly piloted and evaluated to ensure that they can add value to patient care in general practice.”