Meet Sam Hepplewhite, Director of Prevention & Partnerships at South East London Integrated Care Board

Skills for Health has been supporting South East London Integrated Care Board to develop strategies and approaches for integrating the workforce across the Integrated Care System.

Andrew Lovegrove, Senior Consultant at Skills for Health, speaks to their Director of Prevention & Partnerships Sam Hepplewhite about the ongoing workforce challenges in primary care, the barriers to workforce planning in this space and what some of the solutions look like.

The current pressures on the NHS are well documented. How is the national picture reflected in South East London?

We’re very similar to the rest of the country insofar as we are seeing a real pressure in primary care. And when I say primary care, I mean general practice.

With everything that we are asking them to do at the moment, primary care (and general practice in particular) is in a unique position.

They are often seen as the first port of call for many people in the community, they still have a high level of competence and trust, and we are asking them to do more and more work in the community.

There’s been a huge amount around vaccine programmes, with COVID, flu and immunisation for children running concurrently. We’ve also had polio and MMR programmes too.

And that’s just one example of how we keep asking primary care to do more and more.

With the role of primary care changing, what does this mean for the workforce?

Because of their unique position in the community, it’s having a huge pressure on the workforce.

And whilst we’re not seeing so much of a problem with recruitment, its retention and the environment that people are having to work in which are the main challenges.

There have been examples where primary care networks have recruited who’s available and then they’ve thought, how do we integrate them into the workforce?

You can’t just expect a role that’s never been part of a primary care team to just be lifted and shifted into that team and it work.

Primary care is completely different to working in other parts of the NHS, you don’t have that massive infrastructure that you do in a hospital that supports you – you’re often working on your own.

From an individual’s perspective, it could be quite a lonely place. If you’re the only paramedic that’s in that that PCN, or you’re the only first contact physio, that’s quite a lonely place to be.

I think that’s probably one of the areas of weakness in this scheme – how long it takes to integrate new roles into a team.

How does this translate into service delivery?

The maturity of primary care networks varies and the capacity and capability to make some of those decisions is similar.

There is also an element of preparing the public for all these new roles, which needs to be factored in.

You wouldn’t traditionally see a paramedic as practice, there are some practices that have never had physios in their practices either. And I think a little bit more could have been done at a national level to say: your primary care, your general practice team might look different.

Five years ago, when you saw a GP or a practice nurse, in your mind, in many people’s minds, that’s the primary care workforce. And so actually, what we’re really struggling with is people understanding why they’re seeing somebody else, why would they get diverted to somebody else who isn’t a GP.

In South East London, I’m sure in other areas as well, a challenge is providing that information to the public to say: on this occasion, if you go with this particular condition, you might end up seeing this particular professional, and it’s okay.

How do you see things changing and improving?

I think there is something about the clinical teams in general practice recognising that they might have to let go a little bit.

This is not every single practice and not every single PCN. But I think GPs will have to work differently, they really cannot continue to just absorb all of the demands that’s coming their way – there are going to be other professionals that can help them with that.

For GPs, general practices and PCNs it important to work out what their future operating model is going to look like.

I think we also have to provide them with the confidence that they can trust some of these other professionals. Same goes for the public – we need to take them on this journey with us that’s going to make general practice and primary care teams look differently.

I think that cultural shift is something that we have possibly not done well in the past when it comes to general practice in primary care.

As well as this cultural shift, what else can put the primary care workforce on a footing that is fit for the future?

The interface between acute services, community health, mental health and the voluntary sector, that’s what’s going to make primary care more sustainable. In other words, it’s those relationships within the wider system that’s going to make the real difference for our residents.

Furthermore, to be able to attract and retain that workforce, because it’s going to be so much more rewarding place to be, because you’re able to look after that individual in front of you, rather than having multiple handoffs and having to negotiate the system yourself.

The general practice module is going to evolve, it’s going to change, hopefully, general practice and PCNs will shape that, and it won’t be because we have a new contract in place, or that we’ve been told that’s what we need to do. The workforce will adapt.

To find out more about the work Skills for Health delivered for the South East London ICB to support their workforce development programme you can read the case study.