GP – ‘If we don’t share the work we’ll just collapse under the strain’
It has long been accepted by members of the public that when you're feeling unwell, your first port of call is to visit your local GP.
General practitioners can treat a whole range of illnesses and have the ability to refer patients to hospitals and other services for urgent or specialist treatment.
But a fall in the number of qualified GPs working in Shropshire, as well as an increase in demand, and issues with capacity compounded by the impact of the pandemic, has meant there needs to be a re-think in the way people access primary care.
Now, healthcare professionals are trying to raise awareness of the other roles within general practice – those who could act as a first port-of-call for patients who need to access primary care.
The general practice team at Bridgnorth Medical Practice has expanded to include a wide range of healthcare professionals, both clinical and non-clinical, who work alongside GPs and nurses to deliver care to patients.
These roles include receptionists, care co-ordinators, clinical pharmacists, pharmacy technicians, physiotherapists, physician associates, social prescribing link workers, healthcare assistants, dietitians and more.
GP Jess Harvey, of Much Wenlock & Cressage Medical Practice said: "We need to create a greater understanding for the situation faced by everyone who is working in the NHS at the moment.
"It's incredibly hard, it's very demanding – physically, emotionally, mentally.
"I am surrounded by people who are constantly sacrificing their own wellbeing for the sake of patients and I think if we can try and create some understanding from the general public of the pressure that we are under and to try and work with us to help them rather than feeling like we are working against each other.
"Ultimately it's that 'help us to help you'. And sometimes that could just be as simple as being kind to the people who showed up that day because it is hard."
By raising awareness of the other roles within general practice, Jess said, it will hopefully come as "less of a shock" to patients when they're offered an appointment with someone other than a GP and they will be more open to the idea.
"We're all used to the traditional roles of doctors, nurses and receptionists but now actually in primary care we are much more," Jess said.
"There's sometimes almost a reflex response that you need to see a doctor but actually there are lots of other professionals who might be better placed to help with that problem.
"So if you have a problem with your knee we have physios working within general practice who can see and assess and refer you if something is needed but can also recommend management, can issue medications and are always under the supervision of GPs, so if there's anything in doubt they've always got somebody they can call on.
"Everybody is well aware of the current state of play in terms of our capacity – not just in general practice but across the whole of the NHS.
"Us increasing the additional roles is a way to diversify services that we can offer patients more locally."
Services that were previously only accessible by visiting a hospital can now be found at a general practice, for example someone who needs to see a dietitian.
This saves people travel, is more convenient and frees up GP capacity for patients with the most serious ailments, as GPs are limited in the number of patients they can see each day.
All professionals are either supervised by a GP or have a named GP who they are in communication with.
"Essentially what we are doing is sharing our skills as professionals and I think that's something that's going to help to sustain the NHS into the future," Jess added.
"Patients are hopefully now learning that these roles are filled by people who are professional in their own rights, who are specialists in their own rights and are highly skilled to deal with the issues they're specialised in.
"There's a traditional model of 'if you're sick, go straight to your GP' and yes in some cases, it's needed to see the GP but in others you might not need to see a GP but there's someone else that you could see as an alternative that has much more availability.
"This isn't about us trying to divert work away from us, this is a case of sharing work and I would like to think our patients can understand that essentially if we don't share the work we will just collapse under the strain."
"When you're really sick and there's something really serious wrong, the NHS can't be faulted, but I completely appreciate that people who have what's considered more minor ailments, that these things can be delayed or indeed feel like you're being pushed around from service to service.
"I think our hope in general practice is that we can limit some of this by diversifying the skillset. I don't think we will ever truly eliminate people seeking help in a service which is perhaps not the ideal, due to capacity issues.
"But our hope in general practice is that we've all made a huge effort over this year to increase capacity and access and that's been a real focus for us."
Jess went on to say that appointment numbers have increased "significantly" compared to pre-pandemic and the options available to seek medical attention are more varied now.
See below for some of the many roles at the practice.
Social Prescriber
Abi Lowe-Werrell is a senior healthy lives advisor, a social prescribing link worker and health coach.
She said: "My role is to spend time with patients, listening, understanding their main concerns and to work with them around making changes to improve long-term health.
"I get referrals for non-clinical things that now or in the future might impact a person's health."
These things include trying to quit smoking, increasing the amount of exercise a person does, dietary changes, as well as loneliness, isolation, low-level mental health problems, money worries etc.
Social prescribing link workers give people time to talk through their worries or concerns and create personalised care and support plans so people can take control of their own wellbeing. Young people aged 11 to 18 can also access social prescribers in schools.
"Patients really appreciate that non-judgemental time to talk and discuss and feel heard," Abi added.
People can refer themselves to a social prescriber or be referred by their general practice.
Clinical Pharmacists
Maggie Kok and Nour Morjan are both clinical pharmacists who work across Shropshire.
When asked about their role, they said: "Our core is medication and medication reviews, but that comes together with people's long term conditions, things like high blood pressure, diabetes, asthma and heart conditions.
"So we review these (types of medication) to make sure they work for the patient, they don't have side-effects and that they have the right monitoring."
They also help with patient safety and with patients who are having difficulty in obtaining certain medications, perhaps because of a supply shortage, by finding an alternative.
"We are not here to replace the doctor, but we will help them with what we can and what we have expertise in," they added.
"I think at the beginning people weren't sure about what we can do but now we have worked on that relationship of trust and we do much more than we used to."
Physician Associates
Megan Chowns is a physician associate (PA) who works in the Broseley and Albrighton areas of Shropshire.
When asked about her role, she said: "Primarily I would work alongside the doctors, seeing patients, taking histories, examining them and coming up with potential diagnosis and treatment plans.
"I think it's important to make clear that I'm not a doctor, I have a different scope of practice and a limit to my competence and part and parcel with that is I have a GP supervising me."
A physician associate can diagnose illness, perform physical examinations and analyse test results. While they currently do not have prescribing rights, they can prepare prescriptions for GPs to sign.
Community Care Co-ordinators
Jo Weaver-Jackson is a community care co-ordinator for Much Wenlock and Cressage Medical Practice.
Her role is to "signpost patients to non-clinical support services"; to navigate people through the health and care systems and to facilitate joint working across organisations.
Jo said: "I work a lot with carers who are looking after a loved one with Dementia or Alzheimers, so the clinical care review would be done by a GP or a nurse and then I offer a social care review, so I signpost them to support services that are relevant."
Jo acts as a bridge between carers and the support available to them in their local community, which she said was even more so important in Shropshire because of the county's rurality.
She recently launched 'Carer Connect' after identifying a need for the group because so many groups and local initiatives were lost through Covid, leaving carers to feel isolated.
Dietitians
Abby Peat is a Primary Care Dietitian in Shropshire who has been in post for around six months.
She said: "We are working towards being a first contact practitioner but at the moment I can't diagnose or prescribe."
However, Abby can provide specialist support and advice to address things such as malnutrition, diabetes, weight management, food allergies, and coeliac, gastrointestinal or metabolic diseases.
When it comes to diabetes, Abby can help lower the risk of individuals with pre-diabetes from developing Type 2 diabetes and she can help support those who have developed the condition go into remission.
Dietitians' services can be accessed in Shrewsbury and Telford Hospitals, but Abby said people were "grateful" that these services are now available to access closer to home.
