Funding in general practice is not matching the increasing levels of workload or consultations, said a report by the King's Fund. One place in particular where practice nurses were noticing the workload increase was the immunisation programme with the extension of influenza vaccines to young children and pregnant women, shingles vaccines for people in their 70s and the introduction of rotavirus, MenB and MenACWY.
'Immunisations get increasingly complex and we have more and more immunisations to do. There’s no extra provision of time for these. So whereas, when I was practising 10,15 years ago, I might have given two vaccinations for new babies, I’m now giving three or four,' said one practice nurse in the report.
Practice nurses are also taking on more management of long-term conditions to free up GP time. One GP said in the report: 'I’ve also seen a lot of that day-to-day protocol-led management now being devolved to other members of the team, so we now work in a much more multi- skilled way and some of that’s very beneficial. So we have some fantastic specialist heart failure nurses, community matrons, etc, who are very able to follow protocols to manage some of these complex patients.'
Analysis of patient contacts across the practices found that consultations grew by more than 15% between 2010/11 and 2014/15. The number of face to face consultations grew by 13% and telephone consultations by 63%. Over the same period the GP workforce grew by 4.75% and the practice nurse workforce by 2.85%. Primary care funding, as a share of the NHS overall budget, fell every year in the last five years from 8.3% to just over 7.9%.
The report also acknowledged the dwindling numbers of community nurses despite rising pressures for the workforce due to the ageing population and the rising levels of multi-morbidities. GPs reported that there used to be closer working between practice teams and community nursing teams who regularly helped with blood testing, ongoing monitoring and preventive interventions associated with the QOF.
However, they said that now community nurses are rarely based in general practice and no longer have time for preventive tasks. Both practice nurses and GPs said that this impacted their workload, stating that the 'district nursing service is under a lot of pressure'.
Although the workforce is mostly viewing advancements in general practice enthusiastically, many respondents answered that this work has not been accompanied by increased staff numbers or funding. One practice nurse said: 'The workload constantly gets bigger and bigger. And we can do that, if we have the funding.'Understanding pressures in general practice analysed patient contacts in 177 practices interviewed 60 staff across the primary care workforce.