@PCIssuesAnswers#IandA2019

MAKING BEST PRACTICE EVERYDAY PRACTICE

Keynote address: The workforce crisis: Thinking differently about the primary

care teamSpeaker(s): Dr Raj Thakkar & Beverley Bostock

Chair: Dr Chris Arden

The workforce crisis:

Thinking differently about the primary

care team

GP, Wooburn Green, Buckinghamshire

Clinical Commissioning Director for Planned Care, Buckinghamshire CCG

Primary Care Cardiac lead, Oxford AHSN, NHS England

LTC & CVD lead, Thames Valley SCN, NHS England

PCCJ, Nottingham, Nov 2019

Dr Raj ThakkarBSc(Hons) MBBS MRCGP MRCP(UK)

Who is in the audience?

• GPs• Hospital doctors• GP trainees• PCN leads• Nurses• Commissioners• NHSE• CQC• Politicians• Anyone else

[Pulse, GPonline]

BMAGP workload is

‘so unmanageable it is affecting the delivery of safe patient care’

British Medical Association(2016) Patient safety under threat from pressures in general practice. https://www.bma.org.uk/news/media-centre/press-releases/2016/november/patient-safety-under-threat-from-pressures-in-general-practice

[Pulse]

Morale poll.

What is your morale inyour current clinical role?

Very Stressed Stressed OK Positive Very Positive

Increased demand/GP

Low morale

Recruitment crisis

https://whatsnew2day.com/nhs-has-lost-700-gps-in-three-years

CQC

[Pulse]

https://www-news.co.uk/716-boris-johnsons-1st-speech-as-pm-on-the-steps-of-downing-street-july-24th-2019/20-new-hospital-upgrades-boris-johnson-pm/

Current problems:

Current problems: audience debate Morale

Value

Pay

Pensions

Complaining society

Work/life, burn out

Respect

NHS runs on good will

Staff

Not enough staff

Retirement time bomb

More attractive to work abroad

No training provision

Demand

Co-morbidities

Aging population

Complexity

Increased scope, more care in the community

Patient expectation

Access

Poor system alignment

NICE

Government

LTP

More care in the community but not enough

resource to follow

Regulation

CQC

GMC

CCG

NHSE

Current NHS model

Patient driven access

GP as the gatekeeper

10 minute consultation

Variation in quality of initial diagnosis and investigation

Speciality based not symptom

based specialities

Patients bouncing

around the system

Poor QA mechanisms

Culture

Buck stops with GP

3% trainees aiming to be a

partner

What can we do at PCN level: Approach

Designed by primary care team and patients

• Ensure the right people are involved from the start

Understand:

• What is good about the current system

• Data

• Staff and patient feedback

• What isn’t good

• What are the pressures

• What are we doing that adds value

• What are we doing that doesn’t add value

• What drives demand

• What is important to staff and patients

• Eg one stop shops, telephone access,

• Feeling valued, flexible working, study time etc

Consider what needs to be delivered, then co-

design the ideal system

• What

• Why

• How

• By whom

Operational implementation plan, leadership and comms

Quality improvement

So what is the ideal community clinical system?

• What do we want to achieve?• Outcomes based?• Reduction in Inequalities• Access to the right people• Moving care upstream• Population activation• Patient accountability, patients as partners• Efficiency

• How do we manage demand?• Who should be the gatekeeper?• High quality front end diagnosis• Reduced duplication/patients bouncing around

the system• One stop shops• Wasted tests?

• GP lead vs GP delivered?

• Should GPs be given a new role and title

• How do we ensure the patient receives the best care they need, efficiently and that they “own” their health• QI mechanisms

• What enablers are needed to deliver?• Resource• Skills• IT• Culture

Reflection

• Should we stop open access to GP as we know it?

• Is the term “general practice” fit for purpose?

• Should GPs even exist in their current form?

• How should we manage demand?

• How can we improve efficiency, equality and quality?