Primary care teams are facing enormous pressure to improve access to their services, but, for many practices, the resource required to do so appears to be thin on the ground.
The downward trend in the numbers of full-time, fully qualified GPs working in practices has continued, evidenced by the 254 GPs the British Medical Association reports as having left the profession in the year to September 2023.
Meanwhile, demand has continued to rise, putting pressure on practices’ capacity and leading to many patients facing long waits for an appointment.
While more than half of GP appointments take place on or just after the day they are booked, nearly a quarter don’t happen until a week or more after, with half of those taking place between 15 and 28 days later.
To help meet this challenge, NHS England has made patient access a priority, with the most recent GP Contract – as well as successive strategies – outlining the importance of ensuring that patients receive a plan of action on their first enquiry to the practice, and that wait times for appointments are reduced.
But with many teams feeling stretched as things are, the push to improve access can be a struggle. With fewer and fewer GPs in the workforce, the onus is on practices to understand where additional support to manage demand may be available, and to ensure that it is deployed effectively.
While many patients expect to see their GP when they interact with primary care, it should not be the case – nor is it sustainable – that every patient making an enquiry to their GP practice should subsequently see a GP.
While the value of GPs cannot be overstated, many enquiries can be more appropriately directed to other staff members – advanced nurse practitioners, pharmacists, physiotherapists, for example – who might have more relevant skills to treat patients.
The advanced roles reimbursement scheme (ARRS) was set up in 2019 to provide funding to GP practices to hire non-GP direct patient care staff that could help address some of the patient access and staff workforce challenges encountered by primary care teams.
However, the full potential of ARRS is often not realised for a number of reasons. One significant obstacle is often the lack of in-depth understanding within practices about the capabilities and skills these roles have to offer.
Practices also sometimes underutilise non-GP roles, including ARRS staff, because of a traditional reliance on GPs for patient care. This reliance is often reinforced by inequitable triage processes, where care navigators default to directing patients to GPs, either because the information provided by the patient is not sufficient to make a more specific decision, or because patients insist on speaking to their family doctor.
Since the launch of the scheme, practices have hired nearly 30,000 additional non-GP staff. While funding for the scheme after 2024 is currently uncertain, NHS England has committed to hiring another 20,000 staff fulfilling these types of roles. Practices should therefore be aware of the skills and capabilities and ensure that they’re balancing increasing demand with effective use of non-GP capacity that’s available.
Despite the rising numbers of non-GP staff available to practices, latest figures show that 44% of all appointments are still provided by GPs, of which one sixth are estimated to be potentially avoidable, according to NHS England.
With GPs providing, on average, 9-12 more patient contacts per day than is deemed to be safe, these figures underscore the importance of reducing the number of patient contacts as well as the opportunity to direct patients to more appropriate points of care, first time.
The modern general practice access model, promoted by NHS England emphasises the importance of processes that enable a clear understanding of both the demand on the practice as well as the resources available to it.
Doing so requires practices to undertake a thorough assessment of their team's skills and abilities, to match these with clinical workflows, and to implement processes and systems that enable these workflows to be implemented.
In the face of increasing pressures on primary care, general practice is being expected to do more with less, and the transition to newer models of care can be a daunting challenge for teams whose main goal day-to-day is ensuring that patients receive care.
Klinik supports practices to adopt new models of access and ensure that they have the capacity and systems they need to respond to rising demand. Our enhanced triage approach ensures that comprehensive patient information is captured, similar to what a GP would try to collect if they have the patient in front of them, regardless of which channel patients choose to make their enquiry.
By filtering non-clinical enquiries and increasing the accuracy with which triage decisions are made, we ensure that patients receive the right care, first time – reducing avoidable GP appointments and making best use of all staff within your practice.
If you’re considering adopting new models of access and would like to discuss how we can support your practice or PCN, get in touch to discuss your needs.