General Practice in Herefordshire is facing extreme challenges at present. We are at a tipping point with increasing demand on services and a crisis with the lack of available GPs. Patient contacts to surgeries have doubled in the last 5 years for the same population, and people are living longer with more complex conditions.
Herefordshire is expecting to lose a third of its GPs locally in the next few years, from retirement due to age or leaving because of work pressure, or moving away to other roles. Local recruitment is difficult, few GPs now seem to want to come and live and work in this amazing county, preferring a metro-centric lifestyle. Most GP training places are currently unfilled on a scheme that has provided locally trained GPs for local practices adequately until recent years.
This all seems somewhat bleak, however, Hereford city GP practices have a good history of collaborative working and 5 of us are planning to come together to merge as a single practice by April 2018 to become “Hereford Medical Group.” The practices involved are Greyfriars, King Street & Bobblestock, Moorfield House, Sarum House and Quay House surgeries. The primary reason for the merger is to offer resilience but also to be large enough to undertake new ways of working together with projects which would be impossible for a smaller practice, and to take advantage of economies of scale particularly for administration.
This does not mean getting rid of your familiar practice team or the loss of personal care but this will strengthen our ability to deliver what is good in primary care.
We are looking at innovative ways of working using the full skills of all our colleagues as well as developing new skills. Locally, we have already piloted a non-GP led home visiting service and are expanding the roles of Nurse Practitioners, Nurse-led specialist clinics, Physicians Associates, Pharmacists, Physiotherapists and Paramedics to meet the needs of the future with fewer Doctors. We are also exploring other new roles including Care Navigators who will direct patients to the most appropriate care services. Much of this is only achievable at scale and we shall become a centre for training and developing these new roles. Change is not always welcomed but it is required in order that patients can still receive professional support when they need it.
Hereford Medical Group are proposing a “Hub and Spoke” model with a new purpose-built northern Hub facility somewhere close to the new City centre regeneration zone. This would be occupied by 3 of the merging practices, i.e. Greyfriars, Moorfield House and Sarum House who will move from their old 19th century premises to a fit-for-purpose building. This will allow a 21st century environment offering better accessibility and facilities, and enable us to deliver other innovative ways of working as well as an attractive setting to enhance future recruitment and training. Planning permission is currently being requested from Herefordshire Council.
Existing premises such as Quay House Medical Centre and Bobblestock surgery would remain as modern facilities offering the “Spokes”.
There is also the possibility of a “Southern Hub” offering expanded services to the South of the river. The Hub and Spoke model, with a unified patient database means patients could be seen at the closest site convenient to their home or work, reducing travel times and improving accessibility.
These plans have the full support of Herefordshire Clinical Commissioning Group.
There is no doubt we face great challenges locally but we have a plan to ensure a chance of continuing to deliver the best care possible, and the willingness to work to achieve it. We want to be able to provide the best possible care for our patients.