Wiser use of skills in primary care

December 22, 2014

Mixed group of medical professionalsTwo research projects published in The Lancet this month trumpet the benefits of targeted health checks and the further improvement on outcomes if these are carried out by practice nurses.

Research published in The Lancet on the value of incentivising primary care practices to provide health checks for people with a learning disability has found that there is a correlation between practice incentives and increased health checks. Therefore, targeting this group can lead to reductions in health inequalities. More research in The Lancet reports that:

“Health checks given by practice nurses to adults with intellectual disabilities produced health-care improvements that were more conducive to longer-term health than standard care given to this population”

Of the 214,352 people recorded as having a learning disability on GP registers, only about 44 per cent had a health check last year. One in four people with a learning disability is registered with a doctor who doesn’t do health checks and there are about 40 per cent of practices that fall into this category.

The bad news is that two thirds of GP partners and practice managers say their surgery has opted out of part of the Quality Outcomes Framework or enhanced services, which make incentive payments for undertaking these registers and checks, because of workload pressure.

Drowning Doctors

GP time is ever more precious and in demand. The total deluge of needy patients every day means the average practice is slowly drowning under the pressure of referral targets, waiting times and administrative work. We all know that appointments are like hens teeth, face to face time is brief and for many people the business of seeking GP advice is often not worth the hassle. Successive Department of Health initiatives have had us using phone services, high street chemists and drop-in centres to try to ease the load.

If you consider that there are some jobs in a primary care practice that ONLY a doctor can do, but many that can be carried out by competent health professionals like nurses, therapists and auxiliaries, it makes sense to divide the workload out accordingly. Doctors are the most expensive resource, so why have them performing administrative duties?

The advice given to GPs on how to carry out health checks on people with learning disabilities in general practice, published by the Royal College of GPs is lengthy and detailed at over 50 pages, so much so that even reading it would take more precious time than the average family doctor can spare. Of course GPs need to have knowledge of the specific needs of this patient group, but if you consider the evidence, the care of a skilled nurse might be a wiser option.

All together now

Perhaps more practices should embrace the team approach, set up task groups to review the patient lists, plan and call up eligible people and hold targeted clinics to offer health needs assessment. Even better, involve learning disability professionals as advisers and coordinators in the team. If the research is right, then the outcomes for wellness will reduce the demand on surgeries in the longer term. Care providers can do their part by gathering and producing the information about a service user’s health ahead of the appointment, or by helping prepare the client for what will happen in the assessment.

In care, we know of the benefits of teamwork and getting the skill mix right. Isn’t it time that our primary care colleagues embraced it too?

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Ginny Tyler

Learning Disabilities Specialist


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