NHS Health Check: How one GP practice tackled waiting times - BBC News
A GP practice in Plymouth is using paramedics and pharmacists to free up doctors to see more patients.
Dr Cope believes new ways of working have been a success

A GP practice in Plymouth has reduced the time it takes to get a routine appointment with a doctor from three-to-four weeks to under seven days.

The Beacon Medical Group cares for more than 30,000 patients and was formed in 2014 after three practices merged.

Dr Jonathan Cope, GP and managing partner at Plympton Health Centre, one of the Beacon practices which has 10 doctors, says, at present, there are 30 unfilled GP posts in Plymouth.

Three years ago, his practice was unable to recruit the equivalent of one-and-a-half full-time GPs.

"We made a conscious decision to look elsewhere, to work differently. So we decided to looks at what skills clinical pharmacists, paramedic practitioners and nurse practitioners could offer. We converted that budget to two-and-a-half full-time equivalents."

Patients registered at Plympton who feel they need same-day care from their family doctor call the reception team at the surgery.

Depending on the problem, they will then be called back by an advanced paramedic, pharmacist, nurse practitioner - or a doctor.

Beacon Medical Group has started to offer new services

Dr Cope said: "Because of the extra capacity, we have freed up the GPs' time. So we are offering more appointments for routine problems, and the waiting times are now shorter."

The advanced paramedic practitioner, Simon Robinson, responds to any emergency medical problems in the practice, as well as doing, on average, four home visits a day.

He says he is often called out to see the more complex cases and his daily schedule allows him to spend more time than the GPs with patients. Simon was keen to point out that if he does have any queries he just has to knock on the GPs' door.

Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said while paramedics are highly valued and trusted, they have different skills and training.

"GPs are highly trained to take into account the physical, psychological and social factor - this unique skill set cannot be replaced by another healthcare professional, however well meaning the intention is.

"We do not have enough GPs in the NHS - and actually we don't have enough paramedics either. This transference of workload pressures from one area of the health service to another is not going to benefit our patients in the long term."

In an effort to understand the pressures on the Beacon Medical Group, the 100 most frequent attendees were analysed.

Dr Cope expected the list to be dominated by frail, elderly patients but instead the typical patient was a 37-year-old woman, often with mental health problems, multiple prescriptions and referrals to hospital.

From March, a psychiatrist will do a weekly clinic from the surgery for these patients and provide additional training on mental health care to staff.

It is part of a parallel drive to offer specialised new services more commonly found in a hospital setting.

Dr Helen Frow, a GP with a special interest in dermatology, has provided care to patients registered to the group in the last two years. "Onward referrals to the hospital have reduced by 85%," she said.

The model of working with between 30,000 to 50,000 patients in a multi-specialty community provider model is known as a Primary Care Home.

There were 14 other sites working to this structure across England in the last year.

The National Association of Primary Care is working closely with NHS England to explore how they can continue to expand working in this way.

A BMA spokesperson said: "Many GP practices are increasingly becoming hubs where nurses and other professionals work together to deliver services to patients.

"However, while this is encouraging, England is suffering from a drastic and worsening shortage of GPs that is damaging patient care and restricting the number of appointments on offer to the public.

"The government needs to address this workforce crisis urgently."

A week of coverage by BBC News examining the state of the NHS across the UK as it comes under intense pressure during its busiest time of the year.