Safe staffing in general practice

GPs in Mid and South Essex were under resourced, under pressure, and struggling with local demand.

There was a limited resource of qualified GPs. This made it difficult to maintain a safe and sustainable service for the local population.

To address the problem, primary care clinicians across the patch came together. They explored new ways of working that would better support GPs and provide a more resilient service.

An evidence-based approach led to the creation of an alternative staffing pool within a typical primary care setting. The aim of the approach was to:

• estimate the likely case mix of attendances in primary care
• then secure an estimation of alternative staff needed to deliver against that need

Data was collected from a network of 37 practices on reported morbidity problems. Health professionals interpreted the data, split it into two groups and estimated that:

• 37% of appointments needed a GP
• 63% could be delivered by other appropriately skilled members of the primary care workforce

Whole time equivalent (WTE) GP only model

They tested the approach against a registered population of 41,800 across Canvey Island. The local medical committee estimated a GP only model of delivery needed 43.5 WTE GPs to deliver care safely. This suggests a significant deficit against Canvey Island’s current WTE of 28 GPs.

Even if funding were available, there are not enough qualified GPs in the area to staff this model. This highlights the opportunities and benefits of developing an alternative staffing pool. When mapping out the assumed demand of appointments per week in terms of GP only appointments, it could be suggested that the new staffing model results in a minimal GP deficit of 0.4 WTE. The GP to patient ration increases to 1:2600 under this new model, compared to the national average of 1:1700. The model further predicted that 2,633 appointments would need to be distributed across other professionals within primary care.

Alternative primary care workforce

When considering the availability of an alternative primary care workforce, clinical leads broadly defined four key skill mix categories. These categories – medical, physical, mental and social – would need to deliver the estimated 2,633 appointments.

Clinical leads also estimated the distribution of these extra appointments across the four domains. Medical would take on 30%, physical 32%, mental 24% and social 14%. Following on from this, it's possible to estimate the number of WTEs required to deliver the extra appointments. Continuing the example of Canvey Island, 40 WTE would make up the workforce model. 16 GPs and 24 other healthcare professionals. They based this on the productivity of the workforce being 110 appointments per week. This calculation was based on the number of 20-minute appointments delivered in 7.5 hours, five days a week.

This model is being used in Mid Essex CCG and the Mid and South Essex STP. Overall the response so far has been positive. Staff have seen an improvement in the care they are able to give to their patients.