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The rapid expansion of primary care. Is it a left shift or left drift?

Dean Royles and Kevan Taylor offer their expertise on providing strategic support, advice and development, as they build on previous thoughts around recent primary care changes.

The proposed rapid expansion of primary care is very welcome and, if managed well, will see a substantial development in primary care’s capacity and capability. It is something we can all welcome.

However, in the absence of a system focussed, Primary Care People Plan, there are substantial inherent risks. Recent agreement on the Directed Enhanced Service (DES) GP contract may have been received positively but there are still significant primary care workforce challenges to overcome.

The first, and most obvious thing, – the expansion of thousands of new roles in primary care nationally, is not about fishing in the same pond. The pond is not there – we drained it some time ago. It is a puddle at best and in some places barely a droplet. There are simply not loads of qualified or vocationally experienced staff out there waiting for that next great opportunity.

Secondly the nature of the DES specification is heavily weighted towards a person specification requiring a number of years’ experience and the ability to work independently without the benefit of a team of similarity and more experienced colleagues around you.

These are exactly the people that struggling secondary care services are desperate to retain. There are lots of great ideas around with innovative solutions – rotational schemes for paramedics, employ and deploy partnerships between secondary care providers and primary care, Primary Care Federations employing staff, risk sharing and career developing, primary care vocational training schemes etc.

READ MORE: Transforming services: We need a left shift not a left drift

However, without system wide workforce planning then the left shift will simply become a left drift as experienced staff move from secondary to the new and exciting opportunities presented by primary care. And who would blame them? These will be great roles with the ability to make a real difference.

Unfortunately, “System-wide” workforce plans in the past have tended to be secondary care plans with add-ons for primary care and mental health. We have to call this out, we have to stop this primary care afterthought approach.

Systems need a Primary Care People Plan that is primary care focussed and orientated, owned by PCNs and supported through ICSs and STPs. With the forthcoming NHS People Plan this a great opportunity for systems and PCNs to put primary care workforce at the top of the transformation agenda.


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