Whatever may be inferred from the introduction of new clinical roles into General Practice, Ben Gowland argues that GPs are irreplaceable; no other health professional working in primary care has the depth and breadth of experience and training like a GP. However, the introduction of these other staff groups is, he suggests, a way of ensuring the survival of General Practice.

There is, unquestionably, a shortage of GPs. Practices need to be able to recruit GPs to fill the vacancies they have, and to avoid the financial burden of dependence on high cost locums. But practices with a full establishment of GPs still have a workload that is becoming increasingly unmanageable, and are also facing financial challenges as income has fallen and costs have risen over recent years. They cannot afford more GPs.

The new GP Forward View places the development of new clinical roles centrally alongside renewed efforts to attract and retain more GPs. As a result, the message that many GPs have heard (and rejected) is that somehow lesser-trained, lower-paid clinical professionals can carry out the work of a GP. But that is not why we need new clinical roles in General Practice.

We know that demand from patients has gone up to unmanageable levels and that clinical and non-clinical staff cannot cope with the daily onslaught. A recent study from the Kings Fund showed that the number of consultations has risen by 15% in the last 5 years. Patients are not just getting older, they are becoming much more demanding.

But if demand is up, and capacity (i.e. the number of GPs) cannot be increased to meet this demand, then something else has to change. This is at the heart of the introduction of new clinical roles.

The GP practices getting most on top of this are the ones that have embraced change in tackling on-the-day demand by, for instance, bringing in a multi-disciplinary teams of advanced nurse practitioners, paramedics and pharmacists. They have created in-house ‘urgent care centres’, or the like, that manage the telephone triage and act as the frontline for the practice.

Some GP practices have got together and created these ‘urgent care centres’ across different practices, to make them more affordable. Some have even merged so that they can do this more effectively. Some have teamed up with their local community trust so that they can access the nursing and physiotherapist workforce that they can supply.

The question practices need to address is not, ‘Can other clinical specialties carry out the role of a GP?’ Rather, the questions they need to ask are:

• How can we re-shape the way that on the day demand is managed, using the skills, experience and expertise of other staff groups that are uniquely placed to be able to do this?
• How can we meet the challenge that the new profile of demand presents for our practice?
• How can we make best use of the GP time that we do have, while still meeting the needs of our population?’

If the aim is simply to replace ‘missing’ GPs with other staff groups, then attempts to introduce these staff groups to General Practice may well negatively impact the service practices can offer. But if the aim is to redesign the model of General Practice to better meet the shifting pattern of demand, then new roles can have a transformative effect on everyone working in a GP practice, and for the patients they serve.