GP surgeries in areas with some of the highest patient to doctor ratios are increasingly relying on nurses and other non-medical professional to plug gaps left by the shortage of medics, HSJ has found.

At least three of the 10 clinical commissioning group areas with the biggest GP to patient ratios – including Swale, Luton and South West Lincolnshire – are depending on the wider primary care community as they struggle to recruit general practitioners.

Two of the other CCGs in the top 10 are in Essex – Basildon and Brentwood, and Southend – and have many practices making use of specialist nurses to reduce reliance on GPs, according to NHS England.

CCGs in Kent, which has the two areas of Swale, and Dartford, Gravesham and Swanley in the top 10 – aims to boost its contingent of non-medical staff by signing up to a “grow your own practice nurse” pilot run by Health Education England.

More than one in three GPs in the Kent region of Swale are due to retire in the next three years, according to Fiona Armstrong, chair of Swale CCG.

“How we replace them [is] a huge concern,” she said.

“Building a team of non-medical staff such as community matrons, district nurses and dementia care workers would be a ‘slow process’.”

The HEE pilot aimed to encourage “nurse mentorship within practices”, Dr Armstrong added.

“Hopefully they will stay for a long time in the future,” she said.

She said the CCG wanted a “team of people that can be called on” including community matrons, district nurses, primary mental healthcare workers and dementia care workers, “because sometimes it’s that kind of specialism that’s required, not necessarily the GP”.

Walk in centre

Many practices make use of specialist nurses to reduce reliance on GPs

South West Lincolnshire CCG – ranked sixth in the top 10 – said it was developing “neighbourhood primary care teams” to address its shortfall in general practitioners.

Simon Glencross, a GP and member of the CCG’s governing body, said this involved creating GP led “integrated teams” of primary care and district nurses, Macmillan nurses and social care workers.

“If it worked well, it would ease some of the frustrations of referrals from one to another, and members of a team all working for different bosses and all having different rules,” he said.

Dr Glencross said that CCGs could be given an expanded role under NHS England’s co-commissioning proposal to find ways to address shortfalls in GPs.

“I certainly think that CCGs are the people to drive that forward rather than NHS England because they know their local patch,” he said.

“What works as a community team for our work area may not be what works somewhere else, and I would hate to have a team structure imposed from NHS England.”

Ian Stidston, director of commissioning for NHS England’s area team for Essex which has two areas in the top 10, said “many practices” across the county had “designed… primary care teams to have less reliance on GPs by taking on more nurses and nurse practitioners”.

CCGs with the highest number of patients per GP

In Luton – ranked fourth in the top 10 – the CCG is concerned about the “wide variability” in “quality, quantity and skills” of nurses in practices across the town.

Luton CCG chair Nina Pearson said some practices had recruited and trained “very high grade nurses” they could use extensively, while others retained a “very traditional model where they have very low practice nursing or very low skilled practice nursing”.

Maureen Baker, chair of the Royal College of GPs, said that “extended primary care teams” could make an “invaluable contribution to patient care”.

“Patients benefit greatly from the complementary skills and expertise that practice nurses and other members of the practice team provide, particularly in health promotion and prevention of illness,” she said.

“However, there are times when patients will specifically want and need to see their GP, and there should be enough capacity in the system to do this.”