A health think tank is calling for better support for practice managers to help crisis-hit general practice cope with the demands of increasing workloads and not enough staff or cash to meet demand. The King’s Fund’s report, Understanding pressures in general practice, said “general practice is in crisis” with bigger and more complex caseloads, difficulties in staff recruitment and retention and funding cuts.
Researchers looked at data from 30 million consultations at 177 practices and spoke to staff including GPs, practice nurses and managers and trainee GPs about the pressures they faced.
It reported that practice managers were “isolated and unsupported” and said investment in management has been lacking in primary care.
Lead author Beccy Baird (pictured) called for more support for practice managers, especially in assessing quality and service improvement skills.
The report found that despite increases in GPs’ workload there was not enough funding or staff to cope with demands.
Consultations in general practice grew by 15% between 2010 and 2015. Telephone consultations soared by 63% and face to face consultations grew by 13% over the five-year period.
However the GP workforce grew by just 4.75% and the number of practice nurses increased by 2.85%.
During the same time the NHS overall budget fell from 8.3% to 7.9%.
Administrative staff reported an increased demand for “unnecessary” care for minor illnesses, which were triaged away from GPs.
There were also extra pressures with hospitals asking practices to deal with paperwork from hospital work, along with non-clinical work, such as letters for solicitors or employers.
Other factors contributing to the crisis included a failure to keep pace with the over 65s and over 85s who are most likely use primary care, consumer demand for immediate care and changes in community nursing, mental health and more work from care homes.
The report also called for “radical change” with innovative models of general practice such as multispecialty community providers, with practice teams collaborating over patient care.
Health Education England needs to develop a workforce strategy for sustainable careers for the practice team.
It is also essential to have adequate staffing levels.
“Otherwise, it will run the risk of spreading an already stretched workforce across longer working hours, thus increasing the workforce challenges.
“If general practice is to remain at the heart of the NHS, it must have an adequate and stable funding stream for core services,” said Baird.
