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A visit to the doctor is likely to look very different in future, after the GPs reached a £9m deal with the Government to deliver more care in surgeries.
This represents a significant shift in the relationship between patients and their GP.
Express digs into the detail of the arrangement, and what it will mean for islanders...
"The nurse is ready to see you now"
Islanders have long been used to “booking a doctor’s appointment” – but in the future, they may well see a nurse or other professional, depending on the reason for their visit.
And unless there is a significant increase in the number of people qualifying as a GP, and the number of practitioners who want to move to Jersey, the island will also have to adjust to having fewer of them.
Patients are also more likely to be referred within the surgery rather than to the hospital, and it is possible that some initial advice will be given over the phone.
That might be through the ‘HCS24’ telecare service or through phone consultation services run by the island’s 14 GP surgeries, which were especially in demand during the immediate covid response.
This marks a significant cultural shift in the provision of care – and such transitions take time to land.
Pictured: Patients will be more likely to see a practice nurse in future when visiting their surgery - providing that they can be recruited.
GPs have welcomed the £9m agreement with Government – but have stressed that recruitment and training remains a significant hurdle.
Last week, it was announced that the new deal is an integral part of the Jersey Care Model – a five-year effort to move non-emergency care out of the hospital and into homes, the community, and GP surgeries.
To help the latter adapt, £3m of the £9m package, which will all come out of the Social Security Fund, is to help practices with the cost of employing professionals including practice nurses, paramedics, pharmacists and health care assistants.
£1m will be provided for that purpose this year, with a further £2m in 2023, before the funding is phased out over 2024 and 2025 “as new ways of delivering care and funding under the JCM are rolled out”, according to Government.
There are 350,000 primary-care consultations a year in Jersey.
Dr Bryony Perchard, who is a member of the Primary Care Body, which represents the island’s 68 full-time General Practitioners, said: “GPs are happy - we have been pushing to have subsidised support for non-GP roles for two decades, and finally logic has prevailed.
“That is appropriate because we are not training enough doctors; nor does the system provide for enough doctors. There are 12 GP posts advertised at the moment and 13 local GPs are due to retire in the next three years. So, we have 25-30 doctors to replace.
“Our concern with the Jersey Care Model has always been that there will not be enough staff to deliver it.”
Dr Perchard added: “Compared to UK surgeries, Jersey has a tiny number of nursing staff. To train a practice nurse takes up to three years does not come cheap.
“Currently, there are fewer than six practice nurses on the island. We rarely get licences to recruit off-island so we will be relying on locals to take the jobs.
Pictured: More clinical pharmacists will mean more patients seeing them for review of their medicine plans.
“The role tends to attract people who have caring responsibilities or those who want a change from working nights and weekends, or perhaps those returning to nursing after taking a break.
“Practice nursing is an attractive role, providing a chance to develop new skills, and we would welcome anyone looking for a new challenge. Unfortunately, fully trained practice nurses are uncommon in Jersey and we are aware that there are challenges in recruiting nursing staff across all healthcare providers.
“The good news is that the UK offers great practice nurse training, and we should take full advantage of that.
“The challenge will be how Jersey is able to recruit these specialist roles, because if we can’t, it calls the whole Jersey Care Model into question.”
As well as practice nurses, who are particularly skilled at chronic disease management, surgeries are also likely to see more healthcare assistants; phlebotomists, who are technicians trained to take tests such as ECGs; paramedics; and clinical pharmacists, who are skilled in reviewing a patient’s medicine lists.
Dr Perchard is keen to stress that having an appointment with one of these roles is not a step down from seeing a doctor. On the contrary, they are likely to be better suited to dealing with particular issues.
“If you have, for example, an annual health check for diabetes or asthma, then that is the sort of assessment that would be carried out by a practice nurse,” she said. “They are far better at troubleshooting problems than GPs, who are primarily there to assess a broad spectrum of possibilities, make diagnoses and come up with medicine plans.
“But a clinical pharmacist may be better suited to review a patient’s entire medicine list, and a paramedic may be best placed to carry out home visits. Each role complements the other.”
Pictured: 'Telecare' and video consultations were essential during the pandemic and feature in the Jersey Care Model.
The Primary Care Body is also optimistic that surgery visits will become more affordable for islanders as seeing, for example, a practice nurse will not be as expensive as seeing a GP.
However, they also stress that it is unlikely that the cost of a GP visit will come down as the £20-per visit Government subsidy is still far less than the actual cost, which is around £70 per visit, when one takes account of all the overheads that each surgery has to bear.
And over the years, rent and salaries have risen significantly, with nursing costs in Jersey being roughly double those in the UK.
When it comes to the deal itself, the Government has committed a maximum of £9m over three years and practices will be able to bid up to a maximum amount of money based on the size of their patient list.
That money is linked to how much practices are able to recruit; it is not a grant and if a practice is unable to attract people, the money stays with the Government.
Surgeries will get funding for successful hires on a sliding scale for the next 3-4 years, with the surgeries being responsible for their training.
Under the new model, a fee will be paid to practices for each consultation or service delivered by a healthcare professional, which the Government says it hopes will allow practices to “adjust their business models away from one dominated by GPs and allow the development of new services.”
A contract is also due to be created which will see practices paid a fee for delivering telephone or video consultations.
GPs have additionally been asked to work with Government to create new measures and targets, with Government committing to progressively increase the funding by £1m over the next four years to reach £2.8m by 2025 as part of a ‘payment for performance’ agreement.
The employment of specified health care professionals - comprising [practice] nurse, health care assistant, clinical pharmacist and paramedic will be facilitated under a wage support scheme where practices may claim in arrears the cost of wages and social security contributions for staff on permanent employment contracts.
The scheme will operate with an annual budget of £2m (£1m for the remainder of 2022) and the level of support will be reduced during 2024 and 2024.
An activity payment will be extended to nurses, clinical pharmacists and paramedics by making a £20.28 contracted payment to offset the cost paid by patients, and a payment of £10 will be made to support the cost of appointments with healthcare assistants.
The Government says that the structure of JQIF provides “a significant opportunity to incentivise general practices to improve their overall standards of patient care and to support agreed programmes to improve health outcomes”.
Further investment will be made in the JQIF model by progressively increasing the budget from £1.8m to £2.8m by 2025. At the same time, award mechanisms within JQIF will be amended to create targets and payment for individual practice performance
The current remote services contract was introduced in March 2020 at the start of the pandemic and the contract is due to fall away when public health advice regarding covid is withdrawn.
The Government says that “telephone consultations with GPs have proven useful to islanders and practices alike” and the payment of £20.28 for this service will be moved into ordinary contractual terms. The contract will be extended to include nurse, pharmacist and paramedic remote consultations.
The Health Access Scheme Agreement will be varied to include paramedics and pharmacists alongside GPs, nurses and health care assistants, who are already included. This aims to ensure that patients from low-income households are not disadvantaged in accessing the appropriate practitioner.
CLICK TO ENLARGE: How the extra funding for healthcare professionals (HCPs) will be spread over the next five years.
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