Allied professionals can be useful to any primary care network and the practices that operate within them. But non-clinical partner of Abbey Medical Centre in Kenilworth, Ryan Smith, says that recognising who you need, when and where they are needed, is just as important.
I have seen our practice use a clinical pharmacist, a physiotherapist and a physician’s associate – and we have just recruited a paramedic. But understanding the roles and measuring the benefits of allied health professionals within primary care networks (PCNs) is crucial.
We ran searches to investigate why people were using the practice over the past six months. We found that 18% were contacting us because of musculoskeletal issues – mostly shoulder, hip, neck and knee pain – which a physiotherapist is more than capable of dealing with. We also found that we had received 380 requests for home visits and not all of them were followed through. A paramedic has the exact skills to assess a patient and decide on the best care plan for them – which is why we directed our attention to hiring one.
A key tool is data mining. The hiring process has got to be data driven and it has got to make sense. What we have learned is that there is no point doing it for the sake of doing it and it is important to know exactly what different roles can offer.
For example, if you hire a clinical pharmacist who has their diploma, then gone down the Centre for Pharmacy Postgraduate Education pathway to do minor ailments and they have their prescribing qualification, they could probably do just as much as a physician’s associate and really have an impact in the practice.
Bang for your buck
One of the main issues you might run into is finance. In our practice, we needed clarify what renumeration these roles attracted both locally and nationally, and bear in mind banding. By analysing the information that we had gathered, we wanted to make sure that we were getting as much ‘bang for your buck’, so to speak.
While they may have less responsibility and authority, a paramedic or a physician’s associate is able to undertake 15- to 20-minute appointments. If the overall result is affordable and frees up valuable time for your GPs, it is up to you to calculate the benefits verses the losses. At the end of your investigation, ensure that it is both financially and practically viable to deliver a better service to patients that is needed and effective.
Making the most of your staff
Once you have hired all of these allied professionals, it’s easy to envision GPs at the top of the pyramid, seeing the most complex patients that nurses, physicians associates and pharmacists are not able to deal with. However, these roles have massive potential to benefit your patients and the workload of your staff.
Imagine if 90% of your patients are being seen by someone other than a GP – this is surely much better financially for the practice and much better for the patient, who can be seen more quickly and by the right person with the most appropriate skills.
This in turn is better for staff morale – you no longer have that very high demand and the GPs see patients whose care presents a real challenge them, making the most of their skillset. Depending on your skill mix, you could start offering patients with complex conditions longer appointments with GPs, this also falls in line with recent publication of the RCGP call to end 10 minute consultations.
However, keep in mind that what is best for your practice may not be best for the wider health community. For instance, in April 2020, PCNs will be able to recruit paramedics with a 70% reimbursement of their salary. But what is going to happen to the ambulance trusts up and down the country? They have spent a lot of time training paramedics, developing and expanding their skills, and all of a sudden they are going to be coming out of that workforce and into Primary Care. More thought needs to go into this area as benefits to the individual practice may not always be best for the local health service.
All these things have to be thought of when considering hiring a new role. Ask yourself:
- What does your practice need?
- What role can fulfil this need?
- Is it affordable?
- Will hiring them contribute to the wider health service outside my practice?