Changing how GPs practice – it really can work

When we produced our report “The Future of Primary Care: Creating Teams for Tomorrow” in the summer (1), the little negative comment there was arose from the idea of larger multi-disciplinary teams, including pharmacists and new roles such as physician associates. GPs worried about what they’d find for these people to do, how they’d train them and problems about liability and insurance. One of the greatest problems in remodelling care is having the time and headspace to think creatively. But sometimes it’s forced on you.

In this month’s British Journal of General Practice, Katie Slack, a practice manager in Chesterfield, describes how her practice went from nine doctors to three in two and a half years and had no replies to adverts for more GPs. They thought about closing down, but decided to try working differently (2). They employed four advanced nurse practitioners, an experienced practice nurse to do ward rounds in their nursing homes, a pharmacist (‘amazing addition to the team’), a community psychiatric nurse and, finally, one more GP. They reorganised their appointment system and trained admin staff to do most of the routine admin that doctors did before. She writes “As I sit here now, we have next day appointments available for tomorrow and advance appointments for a week’s time – something unheard of for many years”.

So it can be done, but this type of team won’t suit every practice. Indeed, in some parts of the country there’s a plentiful supply of GP trainees and recruitment is relatively easy. However, when the workload seems overwhelming, our experience visiting practices when we wrote our report, and Katie Slack’s experience in Chesterfield, show that there are different ways of doing things. And ways which can improve care at the same time.

One key question is what support is going to be available to GPs who feel they need to change but haven’t got either time or creative energy left when they’re struggling to keep their practice’s head above water. Larger groupings of practices (federations, networks, super-practices) have a key role here. Issues around training, liability and governance for staff undertaking new roles will often be too hard for an individual practice, but not if there’s an infrastructure that they’ve created to provide support. Much of our report calls on government to do more for primary care, including more money. But GPs can do some things themselves, and getting together into federations to provide support for new ways of working is one of them. Mind you, Katie Slack’s practice seems to have done it without outside help. For them it was change or close.



  1. Primary Care Workforce Commission. Primary Care for the Future: Creating Teams for Tomorrow. July 2015.
  2. Slack K. Practice with a difference! British Journal of General Practice 2015; 65 (Nov): 593.
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