The highest risk situations in General Practice are when seeing patients without records, when complex elderly people who may have communication difficulties are seen alone, and when there is no chaperone and /or a language/communication problem. Telephone triage may weed out the most risky cases, and reserve these for the GP, notes may be available on a portable computer, but there will be a temptation for “drift” and for those untrained in diagnosis to be over extended. The risk may be more than the insurers will accept. Expect mistakes, and premiums to rise, or for even more pressure on A&E as more patients are referred …. (defensive medicine).
One in four GP appointments will be conducted by pharmacists or nurses under plans to relieve pressure on family doctors.
Health chiefs in the South West have said that by 2020 they want doctors to cut their appointments by 27 per cent by drafting in other health professionals and by getting patients to manage their own conditions.
Simon Stevens, head of NHS England, has said that he wants patients across the country to be treated by pharmacists, counsellors and physiotherapist to ease the pressure on GPs. For the first time, health chiefs have now estimated how many doctors’ appointments this could avoid.
The sustainability and transformation plan for Bristol, North Somerset and South Gloucestershire has set a goal to “reduce the number of consultations conducted by GPs by up to 27 per cent through diversion of work to more appropriate multidisciplinary team members and non-clinical services”.
Health chiefs in the area said that the figure was a rough estimate that aimed to show how big a change was needed to keep pace with an older, sicker population when cash and doctors were both in short supply.
They also want to use online consultation and monitoring services to reduce surgery visits by 15 per cent by helping people to look after themselves at home.
Medical leaders have backed the plan as a way to deal with routine problems when waits for appointments are lengthening, but warned that it must not become a way to stop patients seeing a GP.
Richard Vautrey, of the British Medical Association’s GP committee, said: “Nurses, pharmacists and other healthcare professionals could play a vital role in supporting GPs to deliver care in the community.
“This is needed particularly at present as the government has so far failed completely to deliver the much-needed 5,000 new GPs they promised.”
However, he added: “While expanded teams can be beneficial, they should not be seen as a replacement for GPs, as it remains essential that patients can access a GP when they need to.”
Mr Stevens announced plans last year to hire 1,500 in-surgery pharmacists to carry out blood pressure checks, to treat for minor ailments, and conduct routine follow-ups and medicine reviews for older people.
Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “These highly trained healthcare professionals can provide much-needed support to GPs and our existing teams at a time when the profession is under intense resource and workforce pressures, and they will be instrumental in freeing up GPs’ time to deal with complex patients who really need the expert skills of a family doctor who considers the physical, psychological and social context during the consultation.”
A spokesman for the plan said that the figures “reflect a blended assessment of the scale of the challenge we are trying to address with changes to the way we plan, organise and deliver services both in community and in hospital. What we do want to do is to reduce demand for GP appointments.”