Most of a GP’s day is spent caring for patients – whether that’s assessing and treating those who are unwell, or seeing those who feel well and working with them to help them maintain good health and reduce the impact of long term conditions.

When not seeing patients directly, GPs are usually busy caring for patients behind the scenes. This can include home visits to vulnerable patients who cannot attend the surgery, checking and acting on test results, writing referrals for further care, communicating with other healthcare professionals to coordinate good care – this can include hospitals, midwives, physiotherapists, occupational therapists, dieticians, the list goes on! They can also be found attending meetings about a variety of issues – from clinical meetings focussed on sharing good practice and improving medical care, to safeguarding and child protection meetings, to practice meetings ensuring the surgery is running smoothly, and CCG meetings to coordinate care on a wider scale.

Some GPs choose to focus on certain aspects of care and can host specialised clinics, such as minor surgery, women’s health, skin clinics. Whilst others can be found helping out at hospital clinics, A&E departments, the NHS 111 service, Ambulance services or even the local prison service.

General Practice Nurses are registered nurses who work autonomously within a Multidisciplinary Team (MDT) within General Practice (GP) surgeries as part of a Primary Healthcare Team.

They assess, screen and treat people of all ages, including babies, children and adults in addition to providing traditional aspects of nursing care such as wound care, immunisations, vaccinations and cervical cytology sampling. They also hold clinics for patients with Long Term Conditions such as asthma, heart disease and diabetes.

A key role of the General Practice Nurse (GPN) is to offer health promotion advice in areas such as contraception, weight loss and smoking cessation in addition to emphasis on promoting women’s and men’s health. The role enables nurses to develop long-term relationships with individuals and families, managing their conditions and improving physical and mental health and wellbeing.

A practice nurse will be involved in almost every aspect of patient care and treatment, undertaking

such tasks as:

• Blood Tests
• Blood Pressure and Weight Checks
• Wound Reviews
• ECGs
• Chronic Disease Reviews e.g. diabetes, hypertension, respiratory reviews
• NHS Health-Checks
• Learning Disability Reviews
• Ear care and Irrigation
• Contraception Reviews
• Adult and Child Immunisations
• Cervical Screening
• Travel Health
• Injections Administration: for example, Depo; B12; Zoladex; Prostap; Nebido; Degeralix
• Minor Surgery
• INR Clinics
• Home Visits

Nurses working in General Practice are undertaking an ever-wider range of roles, with experienced nurses assuming more of the traditional workload of GPs. For nurses working in primary care, this is a positive move: General Practice can offer a challenging and rewarding nursing career with plenty of opportunities for professional development and specialisation.

Please see Professional Development for more details of opportunities for development and specialisation.

Advanced nurse practitioners (ANPs) have completed a masters qualification in advanced practice. They will assess, diagnose and treat people of all ages within the community. They abide by the four pillars of advanced practice to provide patient care (Clinical practice, facilitating learning, leadership, evidence research and development).

Each practice utilises ANPs differently depending on the local community but with common themes:

• Diagnosing and assessing patients
• Caring for complex long-term conditions
• Home visits
• Developing specialist interests such as dermatology or women’s health
• In some practices, ANPs will also offer additional services such as minor surgery.

Nursing associates are a relatively new role within primary care. They are a professional member of the multidisciplinary team who are registered with the NMC.

They are a valued member of the team who can undertake the following tasks

• Blood Tests
• Blood Pressure and Weight Checks
• Wound Reviews
• ECGs
• NHS Health-Checks
• Adult and Child Immunisations (with extra training)
• Cervical Screening (with extra training)
• Injections Administration
• INR Clinics
• Chronic disease reviews (with extra training)
• Home Visits

As this is a new role, it is continually developing. As such, the above tasks are examples and the role may encompass much more.

Practice Nurses have a wide range of opportunities to develop their skills, alongside those of a general practice nurse, and further their career.

Many practice nurses will undertake specialist courses in long term conditions, for example asthma or diabetes.

Other nurses may prefer to specialise in areas such as sexual health and undertake coil or implant fittings.

There are many training opportunities available which can be found under Training & Events.

This is a stage in your career where you may find some advice beneficial. Our Lead Nurses are available for career discussions – contact us to arrange.

What is a Clinical Pharmacist?

Clinical pharmacists work in Primary Care as part of a multidisciplinary team, in a patient facing role to clinically assess and treat patients using expert knowledge of medicines for specific disease areas. If they are recruited under the additional roles reimbursement scheme(ARRS), they must complete the 18-month Primary Care Pharmacy Education Pathway from the Centre for Pharmacy Postgraduate Education (CPPE). If they are not already independent prescribers, they can then complete an independent prescribing qualification. They work with and alongside the general practice team, taking responsibility for patients with chronic diseases and undertaking clinical medication reviews to proactively manage people with complex polypharmacy, especially for the elderly, people in care homes and those with multiple comorbidities.

What do Clinical Pharmacists do?

• Clinical medication reviews for patients with single or multiple long-term conditions where medicines optimisation is required
• Reconcile medicines following discharge from hospitals or intermediate care and working with patients and community pharmacists to ensure patients receive the medicines they need post-discharge and to reduce the risk of readmission.
• Be involved in multidisciplinary clinical meetings within the PCN where appropriate
• Contribute to the provision of out of hours/on call/extended services for the practice and the patients. These can include patient facing and telephone consultations, signposting to other services and/or healthcare professionals where appropriate, while working within scope of practice and limits of competency.
• Manage repeat prescription requests, resolving queries where possible within scope of practice.
• Implement changes to medicines in line with MHRA alerts, product withdrawal or shortage and other local or national guidance
• Maintain full and complete records of all patient contacts using appropriate clinical templates and coding
• Undertake a proactive role in audit and quality improvement implementing recommendations where appropriate.
• Provide independent information to patients with regard to medicines and prescribing changes, initiating further support from other healthcare professionals where appropriate
• Participate in review and setting of policies relating to medicines management and prescribing and help ensure practices prescribe in accordance with local guidelines and formulary
• Identify areas of clinical risk at network level and make recommendations to support the introduction of new working practices that will optimise the quality of prescribing and make more efficient use of network resources.
• Monitor network practices’ prescribing against the local health economy and make recommendations for GPs or amend within scope of practice, based on findings.
• Maintain own clinical and professional competence and be responsible for own continuous professional development
• Work with practices to ensure full compliance with Care Quality Commission standards for safe and effective care

How do Clinical Pharmacists fit into the NHS Workforce?

Clinical pharmacists work as part of the general practice team to improve value and outcomes from medicines and consult with and treat patients directly, allowing improvement and increasing quality of patient care.

How do Clinical Pharmacists help the system?

Having clinical pharmacists in GP practices means that GPs can focus their skills where they are most needed, for example on diagnosing and treating patients with more complex conditions. This helps GPs to manage the demands on their time.

What training and qualifications do Clinical Pharmacists have?

• All pharmacists complete a 4-year undergraduate masters’ degree followed by a year of pre-registration training in pharmacy practice.
• Pharmacists frequently have post graduate diplomas in clinical pharmacy
• Clinical Pharmacists employed through the Network Contract DES will either be enrolled in, or been granted exemption from, the 18-month Primary Care Pharmacy Education Pathway (PCPEP). This pathway equips the pharmacist to be able to practice and prescribe safely and effectively in a primary care setting.
• All Clinical Pharmacists will be part of a professional clinical network and will always be clinically supervised by a senior Clinical Pharmacist and GP clinical supervisor.
• Independent prescribing is in addition to the training pathway and will be completed following completion of the PCPEP.

Pre-requisites

Pharmacy degree and registration as a pharmacist with the General Pharmaceutical Council.

Length of course

• 18-month pathway, including 28 days dedicated study days
• Learner receives a statement of assessment & progression on completion of the pathway
• No placement is required as the Clinical Pharmacist will be employed within primary care whilst completing the PCPEP

PCPEP (Primary Care Pharmacy Education Pathway)

CPPE is commissioned by Health Education England to deliver training to pharmacy professionals working in primary care as part of the primary care Network Contract Directed Enhanced Service (DES). The Primary Care Pharmacy Education Pathway has been developed to align the education requirements of pharmacists and pharmacy technicians with the NHS Long Term Plan and the primary care Network Contract Directed Enhanced Service. The 18-month pathway will equip pharmacists and pharmacy technicians with the necessary knowledge, skills and experience to work in various patient-facing roles in primary care networks as part of a multidisciplinary team. Pharmacists and pharmacy technicians will be able to access a range of different study methods to suit different learning styles, a continuous assessment process and support from supervisors and peers. Pharmacy professionals who are already enrolled on the General Practice Pharmacy Education Pathway (GPPEP) or the Medicines Optimisation in Care Homes (MOCH) Pathway(predecessor CPPE programmes) will continue with this, but any new applicants employed through the primary care Network Contract Directed Enhanced Service will join PCPEP.

Source: HEE

What is a Pharmacy Technician?

Pharmacy technicians are senior members of the pharmacy team who manage and prepare the supply of medicines and give advice to patients and customers. Pharmacy technicians complement the work of clinical pharmacists through the utilisation of their technical skillset. They carry out some similar tasks as a pharmacist, working directly with patients and other healthcare professionals. Their deployment within primary care settings allows the application of their acquired pharmaceutical knowledge in tasks such as audits, discharge management, prescription issuing, and where appropriate, informing patients and other members of the PCN workforce. Work is often under the direction of clinical pharmacists, and this benefit is often realised through the creation of a PCN pharmacy team.

What do Pharmacy Technicians do?

• Taking in and handing out prescriptions
• Dispensing prescriptions
• Using computer systems to generate stock lists and labels
• Ordering items
• Receiving, loading, unloading deliveries
• Delivering medicines to other parts of a hospital or health centre
• Selling over-the-counter medicines
• Answering customers questions face to face or by phone
• Pre-packing, assembling and labelling medicines
• Preparing medicines
• Referring problems or queries to the pharmacist

How do Pharmacy Technicians fit into the NHS Workforce?

Pharmacy technicians can practise, provide advice on medicines and review patients medicine history independently. Pharmacy technicians play an important role, complementing clinical pharmacists, community pharmacists and other members of the PCN multi-disciplinary team. Pharmacy technicians are different to clinical pharmacists as they are not able to prescribe or make clinical decisions, instead working under supervision to ensure effective and efficient use of medicines.

How can they help pharmacists/the system?

Pharmacy technicians increase the numbers of the Primary Care workforce and increase access to quality care for patients. They act in an enabling role, helping to reduce the healthcare team’s workload. They bring new talent to the NHS and add to the skill mix within the teams.

What training and qualifications do Pharmacy technicians have?

Pharmacy technicians already hold a BTEC National Diploma in pharmaceutical science/ NVQ/SVQ Level 3 in Pharmacy Services/ National Certificate in pharmaceutical science to be registered with the general pharmaceutical council to apply for roles in Primary Care. To become a pharmacy technician, students take a 2-year training programme combining practical work experience with study, either at college or by distance learning covering courses; human physiology, disease management, actions and uses of medicine pharmacy manufacturing, pharmacy law. Registered pharmacy technicians must keep their skills and knowledge up to date with annual continuing professional development. The new initial education and training standards for pre-registration trainee pharmacy technicians were published in 2017 and the Pharmacy Integration Fund (PhIF) are currently funding a pilot programme which includes training rotations in general practice.

Apprenticeships

Apprenticeship routes to becoming a pharmacy technician are now the main route of entry, more information of the apprenticeship can be found here: Pharmacy technician (integrated) / Institute for Apprenticeships and Technical Education

Do pharmacy technicians specialise?

Pharmacy technicians, especially in the hospital sector can specialise in certain areas such as oncology, diabetes, clinical trials etc.

PCPEP (Primary Care Pharmacy Education Pathway)

CPPE is commissioned by Health Education England to deliver training to pharmacy professionals working in Primary Care as part of the Primary Care Network Contract Directed Enhanced Service (DES). The Primary Care pharmacy education pathway has been developed to align the education requirements of the pharmacists and pharmacy technicians with the NHS Long Term Plan and the primary care Network Contract Directed Enhanced Service. The 18-month pathway builds on the success of the clinical pharmacists in general practice education and the medicines optimisation in care homes pathways and will equip pharmacists and pharmacy technicians with the necessary knowledge, skills and experience to work in various patient-facing roles in primary care networks as part of a multidisciplinary team. Pharmacists and pharmacy technicians will be able to access a range of different study methods to suit different learning styles, a continuous assessment process and support from supervisors and peers. Pharmacy professionals who are already enrolled on the Clinical pharmacists in general practice education or the medicines optimisation in care homes pathway will continue with this, but any new applicants employed through the primary care Network Contract Directed Enhanced Service will join the primary care pharmacy education pathway. Pharmacists unable to access PCPEP can access an extensive range of relevant training packages free of charge through the Centre for Postgraduate Pharmacy Education (CPPE).

Career Development

Once qualified, many pharmacy technicians join the Association of Pharmacy Technicians (APTUK). The APTUK runs courses, conferences, and seminars where pharmacy technicians can exchange ideas and update their skills. Experienced pharmacy technicians can go on to study to become a pharmacist. Many pharmacy technicians are extending their roles to work with pharmacists (and other healthcare staff) in helping patients to manage their medicines. These specialist roles involve checking and recording the medication that patients should be taking, ensuring sufficient supplies, and counselling patients to understand how to use their medicines safely on the hospital wards, and when they return home. They can also take additional training and assessment to allow them to perform the final accuracy check of prescriptions before being issued to the patient. In hospital and industry pharmacy technicians manage the technical aspects of dispensing services and manufacturing medicine.

Source: HEE

What they can do

• Assess and diagnose lower limb conditions and foot pathologies, commence management plans, deliver foot health education to patients and colleagues
• Liaise with PCN colleagues, community and secondary care staff, and named clinicians to arrange further investigations and onward referrals
• Use and provide guidance on a range of equipment including surgical instruments, dressings, treatment tables, and orthotics
• Provide treatment for high-risk patient groups such as the elderly and those with increased risk of amputation
• Use therapeutic and surgical techniques to treat foot and lower leg issues (e.g. carrying out nail and soft tissue surgery using local anaesthetic)
• Prescribe, produce, and fit orthotics and other aids and appliances
• Undertake continued professional development to understand the mechanics of the body in order to preserve, restore and develop movement for patients

Benefits to patients

• Access to screening, diagnostics and tailored care plans
• Increased access to the right care, closer to home
• Patients are kept active and mobile
• Support people to manage their condition so that they can recover faster and stay in work and/or return to work earlier
• Receive education and advice on inappropriate footwear, which can contribute to poor balance and an increased risk of certain conditions or risk of falling
• Prevent and correct deformity, relieve pain and treat infections

Benefits to GP practices

• Work with other healthcare professionals such as dietitians, GPs, nurses and physiotherapists
• Relieve pressure on other primary care colleagues
• Help reduce patient attendances at the practice by intervening early and helping them stay well

Benefits to the wider NHS

Prevention of complications from long term conditions and reduction in the number of unnecessary referrals made to secondary care

Podiatrists can make early interventions within the community to reduce A&E attendances and unnecessary hospital admissions by facilitating early detection and intervention of potentially life threatening conditions.

Podiatry Roadmap

What they can do

• Assess, plan, implement and evaluate treatment plans, with an aim to increase patients’ productivity and self-care
• Work with patients through a shared-decision making approach to plan realistic, outcomes-focused goals
• Undertake both verbal and non-verbal communication methods to address the needs of patients that have communication difficulties
• Involve MDT colleagues, physiotherapists, social workers, alongside patients’ families, teachers, carers and employers in treatment planning
• Support the development of discharge and contingency plans with relevant professionals
• Periodically review, evaluate, and change rehabilitation programmes to rebuild lost skills and restore confidence
• Where appropriate, advise on home, school, and workplace environmental alterations, such as adjustments for wheelchair access, technological needs, and ergonomic support
• Advise on specialist equipment and organisations to help with daily activities
• Resolution of functional issues which result in multiple and regular contact with GP practice
• Healthy ageing and proactive management of frailty
• Moving/handling, mobility and falls assessments and interventions
• Fatigue Management and energy conservation
• Pain Management
• Health Promotion
• Safety & Falls Prevention

Benefits to patients

• Improves the individual patient’s independence
• Improves specific self-care skills
• Provides compensatory techniques to improve an individual’s ability to complete self-care tasks following a change in functional abilities
• Improves strength and endurance for functional tasks
• Patients receive expert advice and prescription of adaptive equipment and home modifications, e.g. through home evaluations
• Teach coping strategies and support adaptation to manage long term conditions for physical and mental health
• Maximise independence and participation in daily life

Benefits to GP practices

• Help to upskill other primary health care professionals and can work as part of a multidisciplinary general practice team
• Deliver more collaborative and coordinated self-care and environmental adjustments advice alongside their colleagues to benefit patient care
• Help to better manage the patient’s own self-care, keep them well and reduce visits to the practice the patient may have otherwise needed to make
• Minimise the risk of crisis situations, such as unplanned hospital admissions
• Overcome the barriers to engaging with services such as social prescribing
• Free up GPs to review medical needs while the occupational therapists can address extrinsic environmental risk factors and behavioural risk factors.

Benefits to the wider NHS

• Deliver health promotion initiatives to their local community
• Can assist in reducing costly A&E attendances and avoidable hospital admissions by helping patients maintain their health and wellbeing
• Occupational therapists focus on resolving health and social issues at an early stage, to minimise crisis situations that result in inappropriate presentation or admission to residential or hospital care

OT Roadmap

Roadmap to Practice ‘Rough Guide/Mythbuster

The role of OTs in Primary Care

The role of OTs specialising in frailty in Primary Care

What they can do

• Work as part of a multi-disciplinary team in a patient facing role, using their expert knowledge of Musculoskeletal (MSK) issues.
• Assess, diagnose, triage and manage patients, taking responsibility for the management of a complex caseload etc.
• Request investigations (such as x-rays and blood tests) and referrals to facilitate diagnosis and choice of treatment regime, understanding the limitations of investigations, interpret and act on results and feedback to aid diagnosis and the management plans of patients
• Develop integrated and tailored care programmes in partnership with patients and provide a range of first line treatment options, including self-management and referral to rehabilitation focused services and social prescribing provision.
• Facilitate behavioural change, optimise patients’ physical activity and mobility, support fulfilment of personal goals and independence and reduce the need for pharmacological interventions
• Develop and make use of their full scope of practice, including skills relating to independent prescribing, injection therapy and investigation
• Work across the multidisciplinary team to develop and evaluate more effective and streamlined clinical pathways and services
• Liaise with secondary care MSK services, community care MSK services and local social and community interventions as required, to support the management of patients in primary care
• Communicate effectively and appropriately complex and sensitive information regarding diagnosis, pathology, prognosis and treatment choices supporting personalised care
• Provide leadership and support on MSK clinical and service development across the network

Benefits to patients

• Quick access to expert physiotherapy assessment, diagnosis, treatment and advice
• Prevention of short-term problems becoming long-term conditions
• Improved patient experience
• A shorter pathway, so patients have fewer appointments to attend
• Opportunities to gain lifestyle/physical activity advice
• Longer appointment times, meaning patients feel listened to, cared for and reassured.

Benefits to practices

• Release of GP time through reallocating appointments for patients with MSK problems
• Reduced prescription costs
• In-house physiotherapy expertise gained
• Increased clinical leadership and service development capacity
• Support in meeting practice targets
• Reduced pressure on GPs and other practice staff
• Making this part of the GP business model can optimise resources and reduce costs

Benefits to the wider NHS

• Reduced number of physiotherapy referrals into secondary care
• Reduced demand and waiting times for orthopaedics, pain services, rheumatology and community physiotherapy and CMATS (Clinical Musculoskeletal Assessment and Treatment Services)
• Improved use of imaging – improved conversion rate to surgery when referrals are required
• Improved links with local voluntary sector and patient groups
• Continued support of individuals with conditions requiring physiotherapy is assured

FCP Roadmap

What they can do:

Paramedics are trained to respond to the full range of emergency incidents and are comfortable assessing patients of all ages with a variety of presenting complaints.  While the physical skill sets retained by Paramedics are focused on emergency interventions (cannulation, intubation etc.) there are transferrable skills for primary care such as ECG acquisition and interpretation.  Whilst Paramedics are associated with emergency treatment, the nature of emergency calls has changed dramatically over the past decade. Modern Paramedics are frequently deployed to less acute incidents with significant primary care crossover.  Around 40% of patients attended by Paramedics within EMAS are safely discharged from scene or referred to alternative community pathways.  Paramedics are used to assessing patients in their own home, triaging the urgency of their medical complaint and referring them as required.

Benefits to patients:

Paramedics are experts in rapidly establishing therapeutic relationships and communicating with patients.  Their ambulance service experience allows them to see patients in a wide variety of settings, including in their own home.  The profession is generally well respected and valued by patients who have been shown to have confidence in the decisions, advice and guidance provided by Paramedics within Primary Care.

Benefits to the wider NHS:

Paramedics will ideally use both their emergency and primary care experiences across clinical settings.  Both the ambulance service and Primary Care are under significant and sustained pressure and there is significant overlap between the patients seen in both settings.  By equipping frontline Paramedics with primary care experience, it is envisaged that hospital conveyance will fall and appropriate referrals within the community will increase.  In addition, it is anticipated that the emergence of Paramedics utilising prescribing and patient group directives to extend their urgent care options will reduce the demands placed upon Primary Care resources.

Paramedics Roadmap

Paramedics in General Practice – a guidance document created by NHS England and HEE

What they can do

• Provide specialist nutrition and diet advice to patients, their carers and healthcare professionals through treatment and education plans and prescriptions
• Educate patients with diet-related disorders on how they can improve their health and prevent disease by adopting healthier eating and drinking habits
• Make recommendations to PCN staff regarding changes to medications for the nutritional management of patients, based on interpretation of biochemical, physiological, and dietary requirements
• Provide dietary support to patients of all ages in a variety of settings including nurseries, patient homes, and care homes
• Work as part of a multidisciplinary team to gain patients’ cooperation and understanding in following recommended dietary treatments
• Develop, implement and evaluate a seamless nutrition support service that is aimed at continuously improving standards of patient care and wider MDT working
• Work with clinicians, MDT colleagues, and external agencies to ensure the smooth transition of patients discharged from hospital back into primary care, so that they can continue their diet plan

Benefits to patients

• Patients receive advice on eating habits to help improve their health and wellbeing
• Dieticians work closely with patients and other staff to tailor individual eating plans
• Patients are better able to manage conditions including diabetes, heart disease, being overweight and obesity, cancer, food allergies and intolerances
• Help to upskill other primary health care professionals in nutrition
• Can work as part of a multidisciplinary general practice team
• Deliver more collaborative and coordinated nutrition care alongside their colleagues to benefit patient care
• Help to get patients better and keep them well

Benefits to the wider NHS

• Deliver health promotion initiatives to their local community
• Can assist in reducing costly A&E attendances and avoidable hospital admissions by helping patients maintain their health and wellbeing through a healthy, balanced diet
• Teach and inform the public and health professionals about diet and nutrition
• Work to ensure nutrition is included as a priority in patient care

Healthcare Assistants (HCAs) are important members of the Primary Care workforce and many practices now employ them to undertake routine tasks that were previously managed by practice nurses.

Tasks may include:

• New patient health checks
• ECG recording
• Blood pressure monitoring
• Hypertension reviews
• Flu vaccinations
• Simple dressings
• Compression bandaging
• Urinalysis
• Chaperoning
• Preparation and processing of laboratory samples
• Spirometry and reversibility
• Preparing medical equipment
• Removal of sutures/clips

Care coordinators are one of several new roles that support the commitment to a stronger emphasis on personalised care as set out in the NHS Long Term Plan. They do this by:

• Providing a more joined-up and coordinated care journey for patients, instead of each encounter with services being seen as a single, unconnected ‘episode’ of care
• Acting as a single point of contact for patients to navigate the health and care system
• Breaking down traditional barriers between health and care organisations, teams and funding streams, to support the increasing number of people with long-term health conditions.
• Reducing health inequalities within the patient population and providing solutions to ensure equity of health care is delivered.

Care co-ordinators can work as part of a multidisciplinary team (MDT) within a GP practice or PCN to identify people in need of proactive support. This could be, for example, people who are frail or have multiple long-term physical and mental health conditions. They work with people individually, building trusting relationships and listening closely to what matters to them to develop a personalised care and support plan. This includes reviewing their needs and helping to connect them to the services and support they require within the practice or elsewhere, for example community and secondary services. Another key part of the role is to provide support for people who are preparing for clinical conversations with healthcare professionals or following up on those conversations, to ensure they can be actively involved in managing their care and supported to make choices that are right for them. Care co-ordinators work closely with GPs and practice teams to help manage caseloads. They act as a central point of contact so that appropriate support can be made available to individuals and their carers which helps them to manage their condition and addresses their needs.

Health and Wellbeing Coaches (HWBCs) predominately use health coaching skills to support people with lower levels of patient activation to develop the knowledge, skills and confidence to become active participants in their care so that they can reach their self-identified health and wellbeing goals.

Patient Activation refers to the spectrum of knowledge, skills and confidence in patients and the extent to which they feel engaged and confident in taking care of their condition. HWBCs may also provide access to self-management education, peer support and social prescribing.

HWBCs use a non-judgemental approach that supports the person to self-identify existing issues and encourages proactive prevention of new and existing illnesses. This approach is based on using strong communication and negotiation skills, supports personal choice and positive risk-taking, addresses potential consequences, and ensures people understand the accountability of their own decisions based on what matters to the person.

They work alongside people to coach and motivate them through multiple sessions, supporting them to self-identify their needs, set goals, and help them to implement their personalised health and care plan.

Activities Undertaken

• Providing one-to-one health coaching support for people with one or more long term conditions, based on what is important to them, with the aim of improving people’s levels of ‘patient activation’.
• Empowering people to improve their health outcomes and sense of wellbeing, preventing unnecessary reliance on clinical service.
• Providing interventions such as self-management education and peer support.
• Supporting people to establish and attain goals set by the person based on what is important to them, building on goals that are important to the individual.
• Working with the social prescribing service to support the triaging of referrals that connect people to the right intervention / community-based activities which support their health and wellbeing.

Social Prescribing Link Workers give people time and focus on what matters to the person as identified through shared decision making or personalised care and support planning. They connect people to community groups and agencies for practical and emotional support. They work within multi-disciplinary teams and collaborate with local partners to support community groups to be accessible and sustainable and help people to start new groups. Social prescribing complements other approaches such as ‘active signposting’. Link workers typically support people on average over 6-12 contacts (including phone calls, meetings and home visits) with a typical caseload of 200-250 people per year, depending on the complexity of people’s needs and the maturity of the social prescribing scheme.

Activities Undertaken

• Providing personalised support to individuals, their families, and carers to take control of their wellbeing, live independently and improve their health outcomes.

• Developing trusting relationships by giving people time and focusing on ‘what matters to them’.
• Taking a holistic approach, based on the person’s priorities and the wider determinants of health.
• Co-producing and supporting delivery of a simple personalised care and support plan to improve health and wellbeing.
• Introducing or reconnecting people to community groups and services.
• Evaluating the individual impact of a person’s wellness progress.
• Recording referrals within GP clinical systems using the national SNOMED social prescribing codes.
• Drawing on and increasing the strengths and capacities of local communities, enabling local voluntary, community and social enterprise sector (VCSE) organisations and community groups to receive social prescribing referrals.

Social Prescribing – A Case Study

As part of the wider team in general practice, General Practice Assistants provide a support role, carrying out administrative tasks, combined with basic clinical duties.

They can help to free up GPs’ time and contribute to the smooth running of appointments, improving patients experience in the surgery.

The GP Assistant role (sometimes known as Medical Assistants) was initially developed in the United States, to safely deliver a combination of routine administrative tasks and some basic clinical duties in the general practice setting, the focus being on supporting General Practitioners in their day-to-day management of patients, specifically aimed at reducing the administrative burden, making best use of consultation time and supporting those particularly vulnerable to isolation who are regular attenders at the practice.

What difference can General Practice Assistants make?

Evidence suggests that effective adoption of this role has the potential to:

1. improve patient access and release highly qualified staff to concentrate on treating and managing patients with more complex conditions – HEE GPA Working Group report 2018
2. improve patient flow within surgery hours, increasing the time efficiency of appointments, and reducing waiting times; supporting patient experience by ‘translating’ or reiterating information from the GP – University of Cumbria 2017
3. have a positive impact on GP retention and job satisfaction
4. reduce time spent by GPs on managing correspondence by 85% – Surrey Heath Community Providers, 2018.

Progress with spread and adoption of General Practice Assistants

Following a successful pilot of the General Practice Assistants (GPAs) role in the North West, Health Education England established a national programme in 2019 to support the spread and adoption of the role across the country, providing a consistent approach to developing the role, underpinned by a defined job description and competency framework to support work-based learning.

By 2021, over 350 GPAs had successfully completed the learning programme.

The following feedback from GP practices and GPAs illustrates how the role has impacted on their role, the service and patients:

“The role has been well received by patients. This independence and enthusiasm has been especially visible during the Covid peak, where GPAs have cross covered patient services such as emergency ECGs, supported regional response teams and broadened their roles (within their competencies) to support the practice.”

“In the absence of a GPA role, the practice would probably have trained more HCAs. However, the GPA role was seen as better, because of the breadth of the course, the formal qualification offered, and the ability to flex between administrative and clinical support.”

“One of the GPAs is now considering a clinical career, which they had previously not thought was possible. This is a major personal achievement and will undoubtably benefit the wider NHS by allowing a new route for enthusiastic team members to enter into their careers.”

“We required somebody to help the duty doctor in performing certain tasks, including admin and clinical, during their on-call day. If this was not introduced, the duty doctor would be spending a significant proportion of their on-call day on performing these tasks, when they could instead be more focussed on providing appropriate clinical care to patients and supervision of junior clinical staff.”

For further information about the GPA role, including template job descriptions and case studies, please follow this link:

https://www.e-lfh.org.uk/programmes/general-practice-assistant/

Lincolnshire Training Hub offers a bespoke GPA training programme incorporating clinical competencies and the level 2 Customer Service apprenticeship. For further details and to express an interest in undertaking the training programme, go to

https://www.lincolnshiretraininghub.nhs.uk/apprenticeships/

The Practice Manager will often assume overall responsibility for the day to day running of the GP surgery as well as future planning. The role encompasses many aspects including finance, human resources, dealing with complaints, ensuring staff training as well as ensuring the practice contract is fulfilled through providing high quality patient care. A Practice Manager will have excellent leadership skills and will often have completed additional courses in leadership or practice management. This role is very unique to general practice. Training: Practice Managers’ Academy, Leadership qualifications i.e., ILM level 5 or 7, complaints training, appraisal training.

Some practices also have other administrative roles such as IT specialists.

The main role is to assist the Practice Manager in the day to day running of the surgery. All surgeries utilise this role differently but with common themes of leadership, future planning and human resources. See Practice Manager role for extra details. Training: leadership qualifications i.e., ILM level 5, Practice Managers’ Academy, complaints training, appraisal training.

This is a role which patients do not often see within the practice. Administrators ensure the practice and patient care runs smoothly through ensuring patients are called in for reviews of long-term conditions, calling patients for vaccinations or other routine care and responding to requests from other agencies such as insurance providers, lawyers, hospitals, coroners and many more. Other roles administrators may undertake are learning to code which ensures medical records are well organised so clinical staff can locate information easily; they also review letters and highlight actions which need to be taken as well as noting any new diagnosis which may have been made by specialists. Training: medical terminology, coding courses.

An essential role within the practice that is sometimes combined with an administrator role, a medical secretary will type up dictated letters, send referrals and liaise with hospitals. They often have additional course qualifications in typing, medical terminology etc. or have completed a medical secretary course. Training: medical terminology, coding courses.

Normally the first point of contact at a GP surgery and an invaluable part of the team. They have a broad role which includes the booking of appointments, answering the phone, monitoring the online GP systems such as e-consult or Ask My GP as well as acting as a care navigator who guides patients to the most appropriate person for their presenting concern. Receptionists will also be involved in emergency situations potentially comforting family members, watching for an ambulance or assisting the rest of the surgery to continue to provide patient care whilst the emergency is happening. As the receptionist is the first person a patient will see as they walk in, they have a basic awareness of illnesses which require urgent attention and will arrange for the patient to be cared for. Training: Conflict resolution, medical terminology, triage training, coding.