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GPC chair’s support for skill-mix gets mixed reaction at LMC conference in London

19 May 2016

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Dr Chaand Nagpaul has called on GPs to embrace skill-mix in practices as a way of coping with workload.

In his opening remarks at the annual British Medical Association’s Local Medical Committee (LMC) conference in London, the General Practitioners Committee (GPC) chair highlighted the “multiple emerging ways” in which skill-mix in practices can support GPs, including independent nurse practitioners and enhanced community nurses.

He said: “We need recurrent funding for embedded skill-mix not time limited subsidised schemes, and with the flexibility to meet the needs of practices rather than be constrained by political initiatives such as physician associates.

“When I started out as a GP, I routinely gave travel and childhood immunisations, syringed ears, and even dressed wounds. It was an inappropriate use of my time, and the expansion of practice nursing has fortunately put an end to this,” he added.

However, in the debates that followed Nagpaul’s remarks, skill-mix proved to be an unpopular motion.

Dr Zishan Syed described skill mix as a “euphemism for the deprofessionalisation of doctors”.

He said: “GPC, please stop your collusion in the GP backward view to replace doctors with other staff. It is unsafe for patients. What kind of society promotes a system that replaces doctors with other staff and blames GPs when things inevitably go wrong?”

Moreover, Dr Richard West representing Suffolk LMC said that skill mix is not the answer to decreasing GP numbers.

He said: “We have heard about the problem with excess workload. It is unquestionable we need help. But we have to remember first that the best person to do a GP’s job is a GP.”

Nagpaul also addressed the cutbacks in NHS funding spent on general practice, which has seen funds fall from 10.4% in 2005/6 to 7.4% in 2014/15, leaving only £141 per patient to deliver a year of general practice care.

He said: “While general practice will finally get a larger slice of the NHS cake, it remains a cake that’s woefully too small to feed the needs of the population.

“A rationed cake in which we spend less of our national wealth on health than most of the western world, where we have a fraction of the hospital beds of France and Germany and lag behind most other OECD [Organisation for Economic Co-operation and Development] countries in our doctor and nurse numbers.”

Dr Richard Vautrey, GPC deputy chairman, also joined the funding debate, addressing the UK’s position at the bottom of the European healthcare spending tables where it competes with countries like Estonia for “nul points”.