Abstract
General practice is changing rapidly, driven by policy demands for new models of care to address an expanding, ageing, and increasingly medically complex population.1 Such change presents opportunities to improve all aspects of care; however, questions remain about the risks to patient safety. These risks can be grouped into: those related to changes in workforce and workload; those related to changes in infrastructure and models of care; and those related to limitations of existing mandatory patient safety systems in general practice. The General Practice Forward View1 (GPFV) set out NHS England’s strategy for general practice up to 2020, committing to 5000 additional doctors and a minimum of 5000 other staff, including mental health therapists, clinical pharmacists, and physician associates (PAs). The roles of new and existing staff are expanding to more efficiently use GP capacity. Although investment in general practice is welcomed, there is uncertainty regarding safe limits of delegation and supervision of staff in existing and new roles. Some of the risks surrounding the workforce changes are illustrated by the GPFV’s commitment to increasing PA numbers, from 31 known to be working in general practice in 2016, to 1000 by 2020.2 PAs are presently regulated on a voluntary basis despite commitments to rapid expansion of the role since 2016. Fortunately, in October 2018, the Department of Health committed to developing statutory regulation for PAs.3 However, the value of this will be defined by its terms. The clinical governance arrangements under which PAs may work remain …
Highlights
General practice is changing rapidly, driven by policy demands for new models of care to address an expanding, ageing, and increasingly medically complex population.[1]
Initial inspections found that 30 of 35 providers did not fully meet criteria consistent with safe care,[6] with failures across prescribing, safeguarding, patient identification, and information sharing. Such failures highlight the risk of harm in an environment where, by the Care Quality Commission (CQC)’s own admission, ‘the pace of advancement in technology has outpaced the evolution of the regulations’
The absence of clear limits of task delegation and supervision of new and existing staff, and evidence of failures in the provision of online medical services, illustrate the risks presented by the transformation of general practice
Summary
General practice is changing rapidly, driven by policy demands for new models of care to address an expanding, ageing, and increasingly medically complex population.[1] Such change presents opportunities to improve all aspects of care; questions remain about the risks to patient safety These risks can be grouped into: those related to changes in workforce and workload; those related to changes in infrastructure and models of care; and those related to limitations of existing mandatory patient safety systems in general practice. The clinical governance arrangements under which PAs may work remain ill defined, despite warnings that these are of ‘critical importance in ensuring the quality and safety of their work’.4 Such uncertainty risks inappropriate utilisation of staff in stretched general practices The clinical governance arrangements under which PAs may work remain ill defined, despite warnings that these are of ‘critical importance in ensuring the quality and safety of their work’.4 Such uncertainty risks inappropriate utilisation of staff in stretched general practices
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