Data from a range of sources show how the current GP workforce is inequitably distributed, with fewer GPs per capita and a larger proportion of older GPs at higher risk of retirement in the most deprived areas. GPs working in deprived communities experience high rates of burnout. Whilst the gap in GP provision between the most affluent and most deprived areas has narrowed from 2004-2014, mainly due to new practices being opened in more deprived areas, there is a risk that this will go into reverse now that the funding that enabled this has been withdrawn. Across NHS primary care, there are attempts to increase GP recruitment and retention and broaden the skill mix, introducing more advanced nurse practitioners, physician assocites, pharmacists, physiotherapists and building links with the voluntary and charitable sector.
See Useful Links for further information.
Yorkshire and Humber Deep End GPs have identified the following priorities to assist them with workforce issues.
1) Understand how proposed changes in skill mix (see the Roland Report and Deep End Symposium presentation) will work at the deep end, specifically: what proportions of different staff types is optimal; what are the costs; what support is available to meet these costs; and what are the training requirements for staff fulfilling these roles.
2) Increase training capacity at the deep end by:
- providing targeted support for GPs to complete the PG Cert Med Ed;
- building links between training and non-training deep end practices;
- developing innovative ST4 or ST3 extension posts to providing training in inclusion health or aspects of GP relevant to Deep End practice (i.e. substance misuse);
- prioritising placement of more experienced trainees in deep end practices; and
- selling the positives of deep end practice across the School of Primary Care. See this #WhyGP post.
3) Understand what initiatives to reduce GP workload will be most effective at the Deep End, including initiatives to encourage self-care
4) The importance of dealing with fundamental issues underpinning the workforce crisis was also recognised, including:
- Increasing the overall number of GPs in Deep End areas by use of financial incentives for recruitment and retention
- Revising the Carr-Hill formula to make funding more equitable
- Reducing fragmentation of services
- Considering innovative solutions, including alternative models of practice ownership and funding (i.e. staff ownership, social enterprise etc) and cost-of-living incentives to work in Deep End areas (i.e. provision of day care and Creches for employees)
WORKFORCE: immediate actions identified by GPs
- Provide a simple guide to new workforce entrants (i.e. pharmacists, physician associates), their training needs, the costs of employing them and sources of funding to support training and development
- Use patient and GP narratives from Deep End practices to sell the benefits of working in deprived areas to Yorkshire and Humber GPs trainees and invite trainees to all future Deep End events
- Ask Health Education Yorkshire and Humber to find ways of prioritising training practice development in Deep End practices, fast tracking Deep End GP trainer certification (especially through providing help with the PG Cert) and prioritising placement of experienced GP trainees in areas of high deprivation