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6 November 2019
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GP partner Dr David Coleman explains how his primary care network (PCN) has helped individual member practices to collectively solve workforce shortages, while avoiding some of the complications of the future additional roles funding
After a period of workforce stability, earlier this year our partners’ meeting agenda once again featured the dreaded ‘r’ word: recruitment.
As a medium sized training practice (list size:11,500) with a constant throughput of GP registrars, we have been relatively insulated from workforce shortage issues in the past. However, due to the GP workforce crisis, in recent years we have embraced alternative clinical practitioners such as paramedics/ECPs and advanced nurse practitioners and benefited considerably. Our paramedic, once established in primary care, became a fantastic asset, handling emergencies, home visits, proactive care and clinic-based first contact work.
Following the departure of this paramedic, to cope with an increased list size we planned to recruit both a part time paramedic, ideally one with primary care experience, and a four-session salaried GP. The latter came easily, as one of our registrars joined the team. Unfortunately, we were unsuccessful in recruiting a paramedic to fit the right profile.
In order to find the right person for the role, we have had to get creative. One of the great early benefits of network-based working has been spending more time speaking to neighbouring practices – as networks are geographically determined, it has been relatively easy to meet them. Where previously we networked at GP trainer meetings, research cluster events or the CCG-wide educational sessions, now we are mixing with our localities on a more regular basis.
Through the network meetings we identified a neighbouring practice with its own unique recruitment problems. As a non-training practice, they had experienced difficulties recruiting clinical staff across the board. Having recognised the benefit of a paramedic, we approached them with the proposal of a shared staff arrangement whereby we could fulfil our requirements and also address their workforce needs, while allowing us to advertise for a full-time position, widening the pool of potential recruits.
A telephone call after a network meeting confirmed that they were open to this idea so we set about finding a potential recruit. Thanks to a personal recommendation, we were able to identify a highly trained paramedic with a wealth of primary care experience for the role.
The PCNs in Doncaster are all underpinned by a pre-existing CCG-wide GP federation. The federation are acting as lead employers for the network staff (currently social prescribers and pharmacists) and providing HR expertise. Additionally, as they hold an NHS contract, they are able to offer NHS pensions.
The federation agreed to our request to employ the new paramedic on our behalf, on the grounds that the role would be shared across two member practices.
While the medium-term arrangement is for the paramedic to work across our two sites, both practices are mindful that one of the future areas of focus for PCNs will be employing emergency care practitioners (ECPs) to provide home visiting services. This may impact our workforce requirements, so there is scope to re-evaluate the arrangement at that point.
Furthermore, from the paramedic’s point of view, there may be an opportunity to lead any future ECP team as experienced supervisor with previous leadership experience. This would benefit the network, too, having a potential clinical supervisor in post, ready to hit the ground running.
We arranged an informal interview with the paramedic and explored all of these issues. The key was transparency regarding the uncertain times we are in. While we were clear there would be a clear role for someone of his expertise, we were not able to provide cast iron certainties as to how it would look in five years’ time.
Fortunately, most NHS workers are well versed in the frequency and pace of change and he opted to embrace the possibilities of an innovative and evolving role in primary care.
In terms of working hours and arrangements, we opted to split the paramedic’s services on a fifty-fifty basis with our neighbour practice hosting him in the mornings, and our practice utilising his skills in the afternoons. With clear agreements regarding annual/study leave, TOIL and overtime in place, we have found this to run smoothly and satisfactorily thus far.
How this role will evolve in the future remains to be seen, but to me the opportunities offered by the networks in terms of building closer ties with our neighbours are clear to see. As our relationships grow, I would anticipate that this form of network/federation-employment will develop further, relieving practices of the complexity of employment law issues and facilitating the kind of creative and flexible collaboration that we will need to meet future challenges.
I would encourage any practices with workforce issues, some of whom may be waiting for the extended role funding to kick in, to take a proactive approach now.
If so, speak to your network (or federation, if applicable, or lead employer practice) and explore the possibility of employing through one of these established bodies, ideally one that is set up to offer NHS pensions. Failing that, one of the practices could operate as lead employer.
Dr David Coleman is a GP partner in South Yorkshire
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