Interprofessional education and training is training between different clinicians who have a shared training need. General Practice accounts for over 90% of clinical contacts in the NHS. The increasing demand for consultations (a rise of 40% in the last 20 years) is forcing practices to add consultations to already long surgery sessions. Also, secondary healthcare work is increasingly moving to a primary care setting. Coupled with an older population (those aged over 65) set to rise by 42% by 2025, and the extended life expectancy of those with complex and long-term needs, we’re facing a surge in the strains put on general practice.
At the same time, there is a reduced supply in the primary care workforce. The number of GPs per head of the population has reduced dramatically over the past 10 years. Vacancy rates are at their highest for 5 years. There’s been a reduction in junior doctors choosing general practice, and around 40% of GPs are planning to leave in the next 5 years. This increases to 60% in those aged over 50. There are similar challenges in the practice nurse’s workforce with numbers falling. There’s a strategic drive to move secondary care activity to primary care, but little capacity to cope with current demand. Also there’s an expectation to maintain patients in primary care for longer before they need acute care.
To tackle some of these issues there is a need to drive change in how we deliver primary care and the models of care we offer. But this requires changes to staff skill mix, and access to appropriate training and support. Interprofessional education and training is an opportunity to build skill sets whist supporting cultural change. Practices engaging in training can help improve supply, up-skill staff, embrace new ways of working and offer an attractive environment for staff to work. This should increase recruitment and retention. 60-80% of Local practices found it either ‘difficult’ or ‘very difficult to recruit a GP, nurse practitioner or practice nurse. However, only between only 7-20% wanted to train for these staff. This is probably due to lack of capacity for training.
Hounslow is looking at how providers can work better together, as part of Whole System Integrated Care (WSIC) in 2014/15. Simulation workshops identified key areas, segmented into 5 key themes: (i) fragmentation of care, (ii) lack of continuity, (iii) inappropriate use of existing services, (iv) poor communication and (v) lack of emphasis of self-care. Working on these areas will support all providers to help deliver population-based, preventative care. Interprofessional education and training is a key aspect of this.
We believe by increasing access to appropriate, specialist training and ensuring the right skill mix within a practice, we can deliver healthcare that meets population needs. This would fall into the categories outlined below, in line with the 5-Year Forward View. Also, we need to make a clear link between workforce and training, so that we can engage other local providers to help deliver.
This would happen by evaluating practices’ situations, reviewing current opportunities, looking at the pinch points for practice demand, and increasing awareness of opportunities to learn, finding suitable students, apprenticeships and courses. Perhaps administrative work associated with training could be consolidated.
Offering training opportunities for existing staff: GPs to develop specialist skills with secondary care providers, practice nurses to become nurse practitioners, and admin staff to start apprentice HCA courses. The support of reception staff to train as ‘care navigators’ is also vital. Retention comes from a good working environment and a work-life balance, this needs to be core to what we aim to achieve.
There are schemes from Health Education, NW London (HENWL) with the GP fellow schemes to support new GPs starting in general practice. Practices could get involved in training physician associate students in at St Georges and Brunel University. Hounslow has also made an application for the Clinical Pharmacists programme. We will explore other roles including pharmacy technicians, physiotherapists and paramedics in primary care.
New ways of working
Patient-centred care, with emphasis on self-care. Commencing with those with high and moderate risk, using the Electronic Risk Frailty Index. Having a care team within the practice of which the GP is one component is going to be increasingly important. The need to reduce variation between practices is also vital. If a shared skill mix is in place this will support the delivery of this. The use of different types of appointments, a call and recall process and staff skill mix is vital.
If the new skill mix can manage less complex demand, it can free GPs with special interests eg frailty, to provide continuity of care for more complex patients. There was also a need for care co-ordination. Hounslow CCG has recently commissioned this and we need explore the best model for their deployment. This could allow for longer GP appointments. Multidisciplinary team meetings have proved difficult to organise. We are exploring using more e-consultations, phone, skype meetings.
Interprofessional education and training
There is some training which is profession specific, but much of clinical training could be done together with a clinicians with different professional back grounds. Interprofessional education and training could help people to meet each other and better understand both the roles and the people doing them. This will help when it comes to the collaborative management of complex patients and mentoring of less complex ones.
There needs to be clear, simple and regular communication from the Community Education Provider Network, CEPN to practices. This should emphasise the benefits of getting engaged and the support that could be provided. Update the current training needs analysis and ensure that we engagement from salaried and Locum GPs and practice nurses. These need to be scoped and centralised administrative support. Finally, we need to ensure patient engagement from the locality and Hounslow CCG patient participation groups to ensure that patients understand the new clinical roles within primary care.
This article was written in March 2017