Introduction

Primary care is the frontline of health services in the NHS and can direct you to all the other available health services.

Almost every person living in Somerset is registered with a GP surgery where they access their primary care services.

There are 66 GP practices in Somerset ranging from a single-handed GP to much larger practices which includes several practices working together under a single organisation. On average each GP has 1,800 patients registered with them.

Most GP practices work a bit like corner shops; they are each a small business owned by a GP or group of GPs who employ the primary care team.

In Somerset a number of practices are now run by Symphony Health Services who provide GP services to approximately 20% of Somerset residents. These practices use employed GP’s as well as the usual ancillary staff, but they are run by a centralised business.

Funding for GP surgeries is complex but essentially practices are allocated a set amount of money each year to care for a patient. This is regardless of how complex or how much input that patient needs.

Who works in a General Practice?

• GP partners – These are GPs that own the practice. GPs will have had 9 to 10 years of training in the full range of medical conditions which affect people of all ages. Some GPs may develop a special interest in a specific area, but they are still expected to keep up to date in all areas relevant to their work not only medical conditions but also business matters, social care factors and other areas.
• Salaried or sessional GPs – These are qualified GPs as above, but they are paid depending on the number of sessions they work with a guaranteed income. They will work in a single practice and are only expected to work the hours they are paid but many salaried GPs will work far more.
• Locum GPs – These are qualified and self-employed GPs as above who will work paid sessions in a variety of different practices, usually to cover when the regular GPs are on leave.
• GP registrars – These are GPs in training. They are qualified doctors who have completed between 7 and 9 years of training. They will be attached to surgery for a period of time while they are taught by the GP trainer in the practice.
• Practice nurses – These are usually adult trained nurses employed by the GP partners to look after long term conditions, and perform certain procedures such as immunisations or cervical smears. Their only role in looking after children is the provision of childhood immunisations and the management of asthma.
• Nurse practitioners – These are qualified practice nurses who have undergone further training to cover a variety of more specialised roles. Some nurse practitioners will deal with acute medical presentations including childhood illnesses. They will have had specific training in these areas. Some nurse practitioners are able to prescribe.
• Health Care Assistants – Health care assistants (HCAs) carry out a variety of specialised functions to support practice nurses and GPs including blood tests, blood pressure checks, ear syringing (less commonly now) or dressings.
• Paramedics – Many practices now employ paramedics to see acutely unwell patients and identify those that need further treatment or investigations. They will often deal with ‘same day’ patients that have self-identified as needing to be seen urgently. Many children will present with acute same day presentations and so will be seen by paramedics. They are often able to prescribe and work independently.
• Clinical pharmacists – Employed by some practices to manage repeat prescriptions and changes to prescriptions after hospital assessments.
• Physiotherapists – Some practices will have appointed physiotherapists to see people with musculoskeletal problems.
• Mental health support workers – Some practices will have mental health support workers to support patients with mental health problems.
• Practice manager – Responsible for the overall management of the practice. They are usually employed by the partners although some may also be partners in the practice.
• Administration team – A range of people who support the day-to-day running of practices including receptionists, secretaries, clinical summarises, prescription clerks and the audit team.

GP surgeries will have a geographical area that they cover, and patients will register with a practice. Patients can register with a practice outside their geographical area if they choose, but where this is the case, GPs do not have to offer home visits.

GP surgeries have been grouped into networks according to geography; these are called PCNs (primary care networks). It is hoped that they will allow practices to work together to provide economies of scale. There are 13 PCNs in Somerset.

What does General Practice do?

General practice is a primary care service providing access to all aspects of health care. GPs are directly accessible to patients who are registered with them to provide acute and long-term medical services.

Urgent health advice is available from GPs through a variety of routes:

• Online access – GPs provide online consultations to patients registered with them by a variety of providers. GPs will respond to queries within 48 hours.
• Phone consultations – Available pre-covid these are now being used more extensively to triage contacts with the surgery. Approximately 60% of problems can be dealt with through telephone consultations the rest will be triaged to a face-to-face appointment with the most appropriate healthcare professional within an appropriate time frame. Patients will be offered either a same day telephone call for urgent problems or a set time and date for non-urgent problems or follow-up appointments.
• Face-to-face appointments – These are offered after a telephone triage with the most appropriate health care professional dependent on clinical need and patient preference. Appointments lasting 10 to 15 minutes are offered with GPs, nurse practitioners, practice nurses, paramedics, physiotherapists or mental health workers. Some longer appointments can sometimes be offered for more complex problems. By using a phone triage process GPs can ensure that patients are seen by the most appropriate person and when necessary, tests have been undertaken before the appointment.
• Home visits – For a small minority of patients who are housebound or acutely unwell home visits are offered either by a paramedic or GP again this will be following a phone assessment.
• Referrals – Patients with specific problems or more complex needs may be referred to other parts of the NHS this may include hospital consultants, nurse specialists, physiotherapists, specialist services or fast track cancer exclusion services.
• Admissions – Patients who are acutely unwell and require urgent hospital assessment may be admitted to the local district general hospital.

Other services available in General Practice

• Management of long-term conditions such as Diabetes, Hypertension, heart disease, kidney disease, asthma, and COPD and monitoring of medication is managed mainly by practice nurses in the practice.
• Immunisations including childhood immunisations, Flu, pneumococcal, meningitis and covid are provided by the nursing team in the practice.
• Specific investigations such as cervical smears, and spirometry.
• A limited number of procedures including minor surgery, insertion of contraceptives, and joint injections are provided by some additionally trained GPs.
• Health checks for patients with specific difficulties such as learning disabilities, long term mental health difficulties.