Now, a few weeks after publication of the long-term plan, if there is a single process that will facilitate its success, I think it is the speed with which NHS providers welcome the potential of skill substitution, i.e. transferring lower skilled tasks from the highly qualified and skilled to less qualified, well trained staff perfectly capable of performing them.
The key point here is not that this is going to happen, but that it needs to happen with as much speed and as little friction as possible.If it happens very slowly and with much grumpiness from the highly trained, I am not sure there will be sufficient trained staff to manage the level of sickness that the NHS will need to deal with.
On the other hand if the whole system welcomes the helping hand that it is getting from trained staff that are new, newly enhanced, or used in a new setting, we have a good chance of being able to help all those extra patients reduce their pain and distress.
Yesterday I posted about Nursing Associates joining the fight against sickness and how we really need to make the leap beyond the fact that these are not Registered Nurses and land on the reality of what they actually are (and not what they aren’t!).
The essential point is that they will cover some of the work currently being carried out by Registered Nurses, because some of their tasks don’t require their skill level.
In the last two weeks there have been two announcements about skill substitution and GPs.
The first was the announcement that there would be 1000 extra staff in the primary care team to help with the further development of social prescribing. What was interesting here is this was second or third item on most national news bulletins. Most had pictures of the end results activity (lots of walking football, but also various voluntary actions) and good shots of GPs saying how this was helping them and their patients.
Interestingly no-one – professionals or commentators – questioned how walking football relates to the NHS?
I think this is an example of something having been happening in most news regions for several years, and regional new media and health correspondents having become used to seeing this as a normal part of modern primary care. For local media this is a bit old hat and any surprise that this a part of the modern NHS has gone. The national long-term plan was able to surf on the top of a few years of good local work and simply say this is now part of a national scheme.
I didn’t see any grumpy GPs being interviewed saying – “I trained for 12 years and I don’t see how someone who has trained for only a few months as a health coach could replace me.”. (I’m not saying they don’t exist though!). Instead GPs seemed to be saying what a relief that NHS England are at last getting behind the idea.
(This will need of course require a very different relationship between NHS England and the voluntary sector. An article I recently wrote for the HSJ with Halima Khan from NESTA about this will be published here tomorrow).
Incidentally the long-term plan is very unambitious by saying that there will be 1000 extra health trainers developing social prescribing during its duration. I expect there to be an extra 1000 by 2020, and many more in the remaining years as this becomes an integral part of nearly all GP practices.
The second announcement was the new GP contract which argued for 22,000 extra staff to be developed as a part of the primary care team. Of course GPs said it would be nice to have a few more GPs, but I get the impression that they have come to recognise that from here on in there will simply not be as many GPs in primary care per sick person, and that they will need as much help from others as they can get. There may be a few extra GPs but not enough to reproduce the patterns of care of the past.
GP practices are already recognising this, so this announcement is therefore NOT primarily about their contract but is mainly about how they will need to employ a much deeper and wider set of skill professionals as a part of the primary care team.
This doesn’t mean to say that all the battles and anxieties about skill substitution in primary care have been won – each location, each practice will go through this with greater or lesser degrees of welcome and alacrity.
But it does mean that very many (perhaps even most?) GP practices recognise that without warmly welcoming skill substitution their practice will have no chance of coping in the future.