The GP Consultant Model is the way forward to strengthen skill mix delivery of health care in the NHS

Intended for Healthcare Professionals

The GP Consultant Model is the way forward to strengthen skill mix delivery of health care in the NHS

Sudip Ghosh, GP/Professor of Community Medicine, Leicester School of Allied Health Sciences, DMU
Other Contributors:
- Muhammed Shaikh, Medical Student, University of Leicester Medical School
- Gailash Beehary Panray, GP, Enderby Medical Centre, Leicester

27 January 2020

We read your submission with great interest. At Enderby Medical Centre in Leicestershire, we have been employing the GP consultant model as our practice delivery model since 2018. Initially there was apprehension about what skill mix to introduce to the practice. There were questions as to whether allied health professionals such as nurse practitioners, emergency care practitioners, physician associates, clinical pharmacists, in house physiotherapists, would improve the quality and cost-effectiveness of the service provided. We undertook a retrospective analysis of the service delivery between April 2018 and March 2019 and compared it to the preceding year. The evaluation was based on acute hospital admissions (AHA), same day discharges from hospital (SDD), 2-week-wait referral rates for cancer (2WW), outpatient care referral rates to secondary care (OPDR), and significant adverse events secondary to drug errors (SAE). In 2017-18, there were a total of 18,590 face-to-face consultations done by GPs and NPs. In 2018-19, this had increased to 19,405 consultations by all staff (up by 4.4%). AHA rates rose from 5.7% to 6.2% (p=NS). SDD rates fell from 2.6% in the preceding year to 2.4% in the study year (p=NS). 2WW referral rates did increase from 7.8% to 8.6%, but this was not statistically significant.

We did see a statistically significant increase in our OPDR from 2.2% to 4.9% (p<0.005). SAE rates between both years were no different (1.4% vs 0.9%; p=NS). Referring to the above results, despite increasing our face-to-face access for patients by 4.4% there was no statistically significant increase in acute hospital admissions, or two week wait referrals or significant adverse effects. In fact, same day discharges fell slightly compared to the preceding year. This reflects the quality of supervision of Allied Health Professionals by GP consultants who are able to give appropriate timely advice to allied staff or GP reviews and able to derive upon the GP’s specialist interest mix within the surgery. Furthermore, this data is promising in how patients are seen and reviewed at the same time avoiding defensive practice and unnecessary admissions. It also echoes an element of confidence in the health professional by the patient. Our analysis shows the model appears to be safe and effective as without GP consultants, simply replacing of GPs with allied health professionals would lead to fragmentation, increase demand and duplication of work.

Competing Interests: None declared.

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The GP Consultant Model is the way forward to strengthen skill mix delivery of health care in the NHS

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