Some concerns have been raised recently about whether we have enough GPs in Kent and Medway.
GP practices are and will continue to be the bedrock of patient care in Kent and Medway. Ninety per cent of care is provided outside hospital, largely by GPs and their teams. Access to their skills, knowledge and expertise is vital for local people’s health and wellbeing.
As well as helping people to stay well, and to manage illness while maximising their quality of life, GPs are also usually the first point of call for patients who need other health services, such as surgery, or treatment for a mental health problem.
Ninety three per cent of local GP practices are rated good or outstanding, and 82 per cent of patients surveyed in 2018 felt their practice was very or fairly good.
This is a reflection of the hard work and dedication of GPs and their staff, particularly given that some of the GP practices in Kent and Medway, as in other parts of the country, are struggling to recruit new doctors. This comes at a time when the local population is both growing and ageing, meaning more people need services, and many people need more services, than in the past.
What is the issue?
In Kent and Medway:
- all clinical commissioning groups (CCGs) have lower numbers of GPs than the national average – to reach the average number of GPs per patient, Kent and Medway would need 181 more full-time GPs
- 12 per cent of all GP posts are vacant, and more than half of these vacancies have been unfilled for at least a year
- 26 per cent of GPs in Kent and Medway are 55 or over and nearing retirement. The national average is 19.4 per cent
- only about 40 per cent of doctors who do their GP training locally go on to work as GPs in Kent and Medway
- five CCGs have lower numbers of practice nurses than the national average –to reach the average Kent and Medway needs 27 more practice nurses. These vacancies have all been unfilled for more than six months.
Vision for the future
The ambition is for Kent and Medway to be a great place to live, work and learn. To deliver the ambition and address critical workforce challenges, it is intended that a Kent and Medway Academy for Health and Social Care be introduced working collectively to:
- promote Kent and Medway as a great place to work
- maximise supply of health and social care workforce
- create lifelong careers in health and social care
- develop our system leaders and encourage culture change
- improve workforce wellbeing, inclusion and workload to increase retention.
The Kent and Medway Sustainability and Transformation Partnership has set up a Primary Care Workforce Group chaired by Dr Simon Dunn, chair of NHS Canterbury and Coastal Clinical Commissioning Group. Building on work already underway, the group plans in 2019/20 to:
- work with the new Kent and Medway Medical School to grow new and enhanced roles and provide opportunities for students to work in GP practices
- undertake a Kent and Medway and international recruitment campaign for GPs, practice nurses and other key staff
- develop portfolio careers and flexible working offers for GPs and highly skilled nurses, paramedics and others to encourage them to join the Kent and Medway workforce
- develop virtual student and trainee networks and Communities of Practices across Kent and Medway to support both new recruits and life long best practice
- put in place specific support for the different professions throughout their careers, including targeted programmes, careers counselling, and retirement planning
- run leadership programmes such as Next Generation GP, practice manager development, mentorship and coaching
- engage with staff about changes to the way GP practices and other services work, to gather their insight and help them shape the future.
£1.5 million has been secured by the STP Primary Care Group from Health Education England and NHS England to support the implementation of this plan.
In addition local areas are providing:
- the training the workforce needs to adapt to the changing needs of local people
- support for them to work within new models of care, delivering high-quality care
- an extensive development programme, including protected learning time for local GP practices and multidisciplinary staff
- support for integrated working with social care and voluntary sector colleagues.
The STP Primary Care Board, jointly chaired by Dr Fiona Armstrong, Clinical Chair of NHS Swale CCG and Mike Parks, Medical Secretary of the Kent Local Medical Committee is developing a Primary Care Strategy that will incorporate this workforce transformation plan. The NHS Long Term Plan promises extra money for local care, (care outside of a main hospital) and this will be factored into Kent and Medway plans when we have more details.
Kent and Medway Medical School
The NHS is pleased to be proactively supporting the Kent and Medway Medical School, working with universities and education providers. We are hopeful that when the school opens in 2020, it will attract aspiring doctors from within the local community and beyond, and offer training and development opportunities that will help to keep that talent in Kent and Medway.
Among other things, it aims to:
- become a beacon for first-class medical education and research
- be the first choice for medical students aiming to work within collaborative multi-professional teams.
This promises exciting opportunities to improve recruitment and retention of talented clinicians in Kent and Medway, including GPs and mental health doctors. The first 100 students start in September 2020.
Kent’s Nursing Academy
The Nursing Academy (from Kent Community Health NHS Foundation Trust) offers a four-year degree-level course to qualify as a registered nurse and a two-year course to become a nurse associate. It was launched in August 2018.
Promoting the NHS as a career of choice
We support work experience opportunities, apprenticeship and career events, to promote the wide range of careers available in the NHS, attending events and liaising with universities and other education providers to maximise opportunities for recruitment.
The Take a Different View website brings together health and social care jobs across the county. Run as a partnership of all the NHS organisations in Kent and Medway, Kent County Council and Medway Council, it promotes the county as an attractive place to live and work.
Supporting GP practices to work together
To improve care for patients, including those with the highest need, and to increase their own resilience, GP practices are now starting to work together, and with other services, in local networks across Kent and Medway.
This year, every grouping of 30,000 to 50,000 people will have its own local team of GPs, community nurses, therapy staff, mental health, social care and other professionals. Initially these teams will provide care for frail older people. They will look to expand to other groups of patients as they develop.
Research shows this is the right size of population for joined-up working: big enough to bring all the skills together, small enough for people in the team to know one another and understand who can best help a particular patient.
Some local teams are based in the same building, such as a community hospital or GP practice. Others meet face-to-face or use technology, such as secure video conferencing, to hold their meetings to plan the care for individual patients.
The local networks are starting to:
- provide more joined-up care for people with complex health needs, from an entire team of health and care experts
- introduce new roles such as care navigators, clinical pharmacists, physiotherapists and advanced care practitioners (highly qualified nurses) shared between GP practices, to ensure professionals with the skills you need are available to see you
- provide more services locally – with specialist GPs or nurses running clinics which might formerly have been provided at a main hospital
- work with health improvement teams, social care and district councils to develop support for your wellbeing and help you to look after your own health
- develop ways of doing things once – either in their network, their CCG or wider – to save time and effort, such as running a specialist clinic, offering minor surgery, or putting together new “patient pathways”, which specify the care that patients with a particular condition can expect to get from the NHS
- make best use of technology: for instance, the GPs, nurses and other health professionals seeing people who book one of the new evening or weekend appointments have access to their medical records, with their consent, so they get the best possible care
- many GP practices also have big screens for webinars and video conferencing, and most staff have tablets, so they can update records securely wherever they are working.
It’s not always about the GP
Not everyone who phones a GP practice for an appointment needs to see a GP.
Some people might be better helped by a nurse, physiotherapist, pharmacist, or by services such as Age UK, or Live Well Kent, which helps people improve their mental and physical health and wellbeing.
In many practices across Kent and Medway, a GP may phone you back to talk through your needs with you, or you may be offered options when you call.
For instance in west Kent, 470 receptionists have been trained as care navigators to help patients contact the service that can help them fastest – if patients give their consent.
Practical support already underway to recruit and retain staff
Health Education England funds three Community Education Training Hubs across north Kent, west Kent and east Kent which provide local education and workforce development support.
In conjunction with clinical commissioning groups, GP Federations and the Local Medical Committee, they are working with GP practices to develop their workforce, introduce new and enhanced roles particularly for people working as part of a joined-up team, support student and trainee placements and provide education, training and networking opportunities.
Community Education Provider Networks are working with GP practices on retention initiatives for GPs in the first five and last five years of their careers, and mid-career, supported by £192,850 in funding from NHS England.