Wider Clinical Team in PracticeJuly 27 2018
The Kings Fund report this month on Innovative Models of General Practice describes 5 core attributes of general practice with person-centred holistic care at the core, surrounded by accessible care, continuity of care, coordination of care and a community focus.
The report goes on to describe some characteristics the authors believe will be needed for organisations to deliver this sort of care, including building and maintaining strong relationships between:
- Patients and professionals working together in bespoke teams to meet patient needs,
- Professionals working in micro-teams where a core group of professionals provide relational continuity for patients
- Professionals and populations working in partnership to determine the best model of care for their locality.
Regardless of the sort of professional relationships that develop or form across the country, GPs and all primary care professionals will need to continue to work closely with other healthcare providers both within and across organisations.
For these teams to work effectively, team members will need to increase their understanding of the unique contribution of those with whom we work. In doing so we can start to break down divides between professional silos in the same way new models of care often step outside organisational silos. We already know that job titles can no longer be used as a shorthand to understand the whole of the role someone does, instead we need to develop a greater understanding of both the standard training of our colleagues and recognise the experience and skills gained beyond this someone has gained. The complexity of the care that is increasingly delivered in the community has meant we all have developed our roles, including as GPs, to meet the needs of our patients.
To begin that process of sharing understanding in teams the RCGP position statement on the wider clinical team in practice states that:
‘GPs remain the only member of the practice team with the skills required to make a holistic medical diagnosis of the whole person, for all patients, including those with the most complex needs.’ And that ‘GPs will continue to retain their essential roles, with increasing importance in ensuring effective supervision and leadership for the wider practice team.’
Although there will inevitably be exceptions to these as professional colleagues work in different roles and have different levels of training, the position statement also signposts to guidance on the skills and roles other professionals bring to our teams including primary care nurses, pharmacists, paramedics and physicians associates.
As new teams form with a skill mix that meets the needs of their local populations they will always be partly moulded by the current workforce shortages in primary care. As we’ve seen with organisational structures there will be no workforce model that works everywhere and that teams will best form around shared vision and purpose whether that is in a practice, locality or larger area.
It has been good therefore to note from the New Secretary of State for Health’s Twitter postings that workforce is apparently his number one priority. One hopes that those developing at scale workforce solutions for primary care understand the problems, the people, the context and complexity in the workforce crisis we face.