GP Triage initiative arrives in region
A NATIONAL initiative aimed at helping to ensure patients receive care from the right person at the right time is coming to Dumfries and Galloway.
NHS 24’s GP Triage service is set to launch at a number of practices with the Upper Nithsdale Group Practice in Sanquhar the first to go live.
The new service is aimed at supporting patients who contact their GP practice requesting a same day appointment.
Patients will continue to contact their practice for appointment requests.
Under the new programme, some patients requesting a same day appointment will be contacted by NHS 24 healthcare team who will offer the most appropriate method of care, such as nurse practitioners, pharmacists, mental health nurses and physiotherapists within their local area.
Importantly, those patients who require to see a GP will still do so, but for some their needs may be best met by seeing another health professional. Patients with minor ailments or medicine queries could be directed to their community pharmacist. And where appropriate, others may be signposted to self-help information such as that available on the website NHS Inform.
Dr Grecy Bell is Deputy Medical Director for Dumfries and Galloway Health and Social Care Partnership, and said: “We’ve been following the expansion of the NHS 24 Gp triage initiative for some time, and have seen how successful it has been in ensuring people are helped to the most appropriate point of care.
“We’ve seen the benefits the service can bring to the whole primary care system. It helps to ensure that the most complex or pressing cases are given thorough and immediate consideration, and that peoples’ needs are prioritised.
“NHS 24 GP Triage also means that those people who are best supported by other healthcare professionals are directed straight to them.
“This initiative is initially being introduced at a number of practices over coming weeks, beginning in Sanquhar in July, and the results will be closely monitored so as to ensure that it is working as designed.
“We’re hoping that patients, staff and GPs will quickly see the benefits, and are looking forward to working in partnership on this with NHS 24.”
Dr Anna Lamont, Assistant Medical Director, NHS 24, said: “Regular reviews by senior clinicians have demonstrated that this new way of working is providing safe and effective patient care. “We’re very pleased that we’re now helping to bring this service to Dumfries and Galloway, having seen the benefits this approach has been able to deliver in other GP practices in Scotland.”
Machars Pharmacy Hub opens in Newton Stewart
A PIONEERING pharmacy hub has been created in Newton Stewart – as work to reshape approaches to health and social care continues through the Transforming Wigtownshire programme.
Wigtownshire NHS Pharmacy Team’s Machars Hub is located in Newton Stewart Health Centre, and was officially opened on Wednesday at an event attended by members of the Integration Joint Board, the locality pharmacy team and senior NHS managers.
NHS Project Manager Karen Harper oversaw the creation of the new facility, and said: “Key for me from the hub has been the teamwork from across the board from the pharmacy team themselves to admin and working with estates and IT to pulling it all together.
“The teamwork to get this going has been exemplary and I’m just really proud of the work that everybody has done to bring the hub into fruition.”
Karen is co-ordinating the Transforming Wigtownshire programme which sees health professionals working in partnership with communities to co-design approaches to health and social care from the ground up.
Transforming Wigtownshire’s Independent Chairman John Ross also attended the opening, and said: “We are looking at transforming health and social care throughout Wigtownshire, and this is a good example of how relatively simple procedures can actually produce a much better result which eventually will improve patient experience.”
Explaining how the service works, Prescribing Support Pharmacist Leanne Drummond said: “Previously the pharmacy team had provided a service in to the GP practices one or two days a week and that was the sole pharmacy time that they got.
“Now that we’ve got the pharmacy hubs open in both Stranraer and in Newton Stewart we provide a five day service to the GP practices. It means we’ve increased the support that we can offer them so that we can take more and more work off the GP practices, and it also means that we’ve got our staff all based in one room rather than being in different locations, and it means that we’re all working together and learning from each other.
“It was a huge amount of work to get the pharmacy work up and running and we had huge support from the whole team round about us. We had to resdesign the room around what our requirements were going to be, and probably the biggest addition to this is that is that we’ve now got our own pharmacy consulting room so we can actually do medication reviews from within the pharmacy hub without having to take up space within the GP practices.”
Gordon Loughran is Lead Pharmacist, Community Health and Social Care, and he notes that the hub comes as part of changes resulting from a new national contract for GPs.
Gordon said: “This development that we have here in Newton Stewart, the hub model that we now have for pharmacists working within GP practices – that has come from the change in contractual arrangements that GPs have with the NHS.
“The value of the skill set that the pharmacy team can bring is to providing care for patients to help them manage their medicines better, so that more people are on the right medicine at the right time and taking them more safely, the value of that has really been recognised within that contract.
“So what we now have are pharmacists, pharmacy technicians and pharmacy support workers and our local community pharmacies much more involved in helping people take their medicines effectively, appropriately, safely, and the value of having such a hub model as we’ve got here in Newton Stewart means that that pharmacy team are all located together right in the middle of the GP practice team so they can work more closely with the doctors and the nurses here.
“It’s a real model potentially for the future, and a really exciting time.”
Dumfries and Galloway Health and Social Care Partnership Chief Officer Julie White attended the official opening on Wednesday.
Cutting the ribbon on the new facility, she said: “The pharmacy hub has been developed as part of our Transforming Wigtownshire programme, alongside our Transforming Primary Care programme through the implementation of the new GP contract.
“I’m delighted to meet the staff here today, ranging from our pharmacists to our technicians to our support workers who will all work as part of our multi-disciplinary team.”
Members of the Integration Joint Board (IJB) have also praised the creation of the new Machars Hub.
IJB Chair Councillor Andy Ferguson said: “I’m really excited. The development here is a tremendous piece of work. It’s been developed down here in Wigtownshire and I would think it’s going to be a model for the rest of the region when all the learning and good practice is made available to be shared with everyone.”
To watch a video from the opening, click the following link… https://youtu.be/CXviKrLIXTIhttps://youtu.be/CXviKrLIXTI
Multi-professional approach to be rolled out to region’s Out of Hours service
WORK to integrate a broad range of health professionals into the region’s Out of Hours team has taken another step forward.
At a meeting at the end of last month, the Out of Hours Steering Group agreed arrangements over coming months and years for a range of professionals including Advanced Practitioners, Clinical Pharmacists and Health Care Support Workers to support GPs to deliver care and support to the population in the evenings, overnight and at weekends as the expert generalists at the heart of the service.
Di Anderson is Interim Out of Hours Service Manager, and she said: “We’re very excited by moves which will go on to establish a much more multi-professional approach to Out of Hours.
“This reflects work which is already taking place within primary care as a result of implementing the new national GP contract.
“And this approach which sees health professionals helping meet the needs of patients is increasingly being seen in other areas, including Emergency Departments.”
Although more health professionals will be joining the Out of Hours Service in the future, the means of accessing the service will continue as before.
As ever, anyone seeking non-emergency medical assistance outside GP practice hours will telephone NHS24 in the first instance, ringing the free 111 number.
Di said: “If the issue relates to medication, then it could be that a clinical pharmacist has the sort of specialist expertise to best manage the situation.
“The GP has the ultimate oversight of the work being undertaken, and will sit at the hub of the service – constantly overseeing cases and available to provide input.
“They will be complemented by the multi-professional team who will operate as spokes, either in the Primary Care Centre environment or via a home visit if required. Individuals needing more intensive services will be routed to the hub for treatment.”
It is felt that the increased multi-professional approach will help to bolster and sustain the Out of Hours service, which generally relies on GPs committing extra time beyond often demanding daily commitments.
Di added: “People will be well aware that Dumfries and Galloway faces the same difficulties around GP recruitment as the rest of Scotland.
“And providing an Out of Hours service across what is sometimes a sparsely populated rural area can be a challenge.
“Similar to what we are seeing across Primary Care in general, the harnessing of a wide range of health professionals helps to support the GPs in their work, and makes best use of all available resources.
“Across all areas of primary and secondary care, people are likely to encounter an increasing range of health professionals helping to ensure their welfare.
“Ultimately, what’s key is having the right person, at the right time for the right situation, with the right skills and knowledge to meet that person’s needs.”
Paramedics, pharmacists and mental health nurses lead primary care change
A TRANSFORMATION is currently underway within primary care in Dumfries and Galloway – as a result of a new national contract for GPs.
Paramedics, pharmacists and mental health nurses are among the first clinical professionals to take on new responsibilities in the region as part of a three-year programme to implement the General Medical Services (GMS) contract developed by the Scottish Government and the British Medical Association and agreed in January 2018.
Deputy Medical Director for the Health and Social Care Partnership Dr Grecy Bell said: “We have just three years in which to implement a contract which moves responsibilities for delivering services such as blood tests, repeat prescriptions and dealing with minor ailments to Dumfries and Galloway Health and Social Care Partnership.
“To this end, the Transforming Primary Care Programme Board have identified priority areas where initial work is required.
“New models of care have now been developed in association with paramedics in the Scottish Ambulance Service, with pharmacists, and with our mental health teams, and we’re now seeing these new approaches starting to be rolled out within the region.”
- Clinical Pharmacists were already taking on increased roles within GP practices, and that is now being further developed as they meet patients and provide expert consultation around medications.
- Paramedics are starting to play a key role in providing home visiting support for some GP practices, with a six month trial currently underway in the Machars.
- Meanwhile, mental health nurses are now set to become a regular feature in GP practices, delivering support and serving as a means of early help and intervention for people directly.
Dr Bell said: “Three years may seem like a long time, but the scale of transformation resulting from the new contract for GPs is really significant.
“We’re confident that we’ve identified the areas where we can begin making changes which will allow GPs more time to focus on working with patients and their communities, and which will result in the largest immediate impact.
“However, we are conscious that there is still a great deal to be accomplished by April 2021, against the backdrop of a region with an ageing population spread across a rural landscape and with limited resources in terms of finance and staffing.
“We’re going to be constantly assessing this work as it moves forward, and would be grateful for feedback from the public as we seek to develop a robust, sustainable model for primary care in Dumfries and Galloway.”
Videos focusing on work in Dumfries and Galloway involving the clinical pharmacists, paramedics and mental health nurses are now being featured on the DGNHS YouTube channel and on social media.
Hannah Brawley is a Clinical Pharmacist working across three GP practice surgeries in Annandale and Eskdale.
She said: “Pharmacists coming into GP practices is a relatively new thing. Some practices have had pharmacists in them for a few years now, but looking forward to the new GP contract we’ll see more and more pharmacists being linked to general practice, as well as working in the community.”
“It allows patients to speak to somebody more specialised in a certain area. If it’s more of a medication query, it allows us to do more in-depth reviews with the patients.
“So it does really help with general prescribing and safety around prescribing as well.”
Hannah believes that patients will see the benefit of being able to speak with a professional whose area of expertise is medication.
She said: “As patients see pharmacists in the surgery more, we’re really hoping that patients can see the benefits of the range of services that pharmacists can offer in GP practices.
“Recruitment for pharmacists within GP practices is already throughout Dumfries and Galloway; previously there weren’t many pharmacists within surgeries, so this recruitment is a really positive development.
“The new GP contract allows the role of the pharmacist to develop and take on additional responsibilities in different practices. Another exciting aspect will be working with other health professionals within a GP practice with the aim of providing a better service for our patients.
“So it’s really just at the start at the moment.”
Hannah says that the new model is being well received by both patients and GP practices.
She said: “It’s been a really positive experience so far, and I feel I’ve been really welcomed by all members of staff in the surgeries, and all the patients.”
Mental health nurses
The three-year programme to transform primary care in Dumfries and Galloway is building on established work around mental health nursing within the community.
Justina Ritchie is Service Manager for Community Mental Health Nursing, and she said: “Over the last 18 months, there’s been a pilot running in two practices in the Stewartry and two practices in Wigtownshire where we’ve had community mental health nurses based in primary care centres working alongside GPs, providing early assessment and interventions to people with mild to moderate mental health issues.
“The pilot has been really successful. We have had really good outcomes for patients and good feedback from GPs. The pilot has been shown to save GP time and patients are now being seen quicker by a mental health professional based within the practice. The plan is now to roll this model out across the region.”
In order to support this roll-out, two posts have now been filled for Annandale and Eskdale and Dumfries and Nithsdale, and recruitment is currently underway to fill five posts for the Wigtownshire and Stewartry localities.
The intention is to deliver the new approach within every GP practice within Dumfries and Galloway by April 2021 and that it will come in addition to the community mental health teams which already exist.
Justine says that there is a recognised need to provide a service to those whose needs are not severe or complex in nature but would benefit from a specialised service based within the GP practice.
She said: “Hopefully the people who will be seen through primary care mental health will have quicker access to mental health specialists and get access to interventions that’ll help them self-manage their mental health difficulties so they probably won’t need to move on to secondary mental health services.
“Our aim would be eventually to have a mental health team sitting within primary care, so there would be mental health nurses, occupational therapists and psychology sitting within primary care with the aim that if people come into primary care with mental health problems the mental health team can direct them to the best person to assist them as quickly and easily as possible.”
And she added: “The initial response has been very positive, from both the patients and from GPs alike who have had involvement in pilot.
“This approach is freeing up GP time, people are being seen quickly, short-term interventions have been put in place to enable them to self-manage, and the outcomes for them have been really positive.”
A six-month project is underway in Wigtownshire, embedding paramedics in GP practices in the Machars.
Three paramedics are working with the Galloway Hills Medical Group in Newton Stewart and the Southern Machars Practice around Whithorn and Port William – taking on some of the responsibilities around home visits.
Dr Charlie Dunnett is Clinical Lead for Wigtownshire and GP at Galloway Hills Medical Group, and he said: “This is a six-month pilot project where we are using the skills that paramedics have to help the practice with their house visiting.
“They’ll be working alongside and under the supervision of the general practitioners. When the house call request comes in, the GP will decide if that’s an appropriate house call for the paramedic.
“If it is deemed to be suitable, then the paramedic will be despatched to go and make an assessment. They will then feed that back to the GP who will decide what further action is required – for example, what medication, if any, needs to be prescribed.
“If it’s felt that a further GP visit is required, the GP will attend.
“And if the paramedic feels that hospital admission is required, then the paramedic will admit the patient directly to hospital having discussed it first with the GP.
“I think it’s important to stress that if it’s a palliative-type care house call, or a call where we feel it’s inappropriate for the paramedic, then the GP will still be visiting.”
Charlie added: “The aim is that if we show that this approach is very useful and effective, that it’s safe and patients like it, then we can hopefully be in a position to develop the model into a more permanent arrangement over time.”
Kenny McFadzean from the Scottish Ambulance Service is Head of Ambulance Services for Dumfries and Galloway.
He said: “Our approach in Dumfries and Galloway has been to try and integrate as much as possible with NHS Dumfries and Galloway for the benefit of the patients we all serve.
“This is a great opportunity for paramedics to expand their skill base and work closely with general practitioners and use the skills that they already have in dealing with urgent and emergency patients in their home to the benefit of local practices.”
Ongoing assessment is taking place assessment around the value of the model and patient views and satisfaction.
Charlie said: “It’s early days, but we’re delighted with how it’s going so far.”
Primary Care changes bring opportunities for pharmacists in Scotland
PHARMACISTS are being presented with new opportunities in Scotland – thanks to changes within primary care.
And an event in Belfast on Monday organised by NHS Dumfries and Galloway will set out these opportunities for pharmacists.
Gordon Loughran is Lead Pharmacist, Community Health and Social Care, in Dumfries and Galloway, and he said: “Significant changes are taking place within Primary Care in Scotland.
“This is partly being driven forward by a new national contract for GPs, but will build on developments within pharmacotherapy.
“Opportunities are arising for pharmacists to use and develop their clinical skills in new, advanced practice roles that will put them in prime position to help service users manage their medicines safely and effectively.”
Developments within Pharmacotherapy in Scotland will be the focus of the recruitment and networking event taking place at Radisson Blu Hotel, Belfast on November 19 from 6.30 pm to 9 pm.
This evening event will feature an opportunity for pharmacists to learn about changes in Dumfries and Galloway.
Information will be provided on approaches which will see pharmacists with advanced clinical skills and pharmacy technicians integrated into GP practices, helping to improve pharmaceutical care and working as part of a multidisciplinary team.
For an opportunity to find out more, to network with other pharmacists and to socialise over tea, coffee, biscuits and a hot finger buffet, please register an interest with Isla English by emailing firstname.lastname@example.org
Radison Blu Hotel, Belfast
Tea, Coffee, Biscuits
Hot finger buffet
Paramedics join Out of Hours in ground-breaking pilot scheme
A GROUND-BREAKING pilot scheme is introducing paramedics as part of NHS Dumfries and Galloway’s Out of Hours (OOH) service.
Two Specialist Paramedics with the Scottish Ambulance Service will support the region’s OOH service as part of a collaborative six-month pilot project.
The Out of Hours Service delivers medical help outside of general practice opening times.
Service manager Mark Sindall said: “There have been significant challenges with the Out of Hours service – there’s a shortage of staffing both locally and nationally around GPs and then a commitment to supporting the service.
“We felt that we needed to do something different, so we are looking at different ways of working, looking at a wider multi-disciplinary team that can support that service for the future.
Specialist Paramedics are advanced practitioners who have completed post-graduate education in urgent and emergency care. This enables them to see and treat more patients at home, referring them for appropriate follow-up when necessary in addition to responding to emergency calls.
The project is a major part of the Scottish Ambulance Service’s 2020 strategy, Taking Care to the Patient.
Michael Harmjanz is Area Service Manager for Dumfries & Galloway (West) area, and he explains: “We have a service throughout Scotland, and it’s part of our 2020 vision to improve the access to healthcare within the community, to avoid unnecessary admissions to hospital and to give people the choice to be managed in their homes rather than having to go to hospital when its clinically appropriate and safe to do so.”
Dr Nitin Desai is the Out of Hours clinical lead in Dumfries and Galloway.
He explains that paramedics involved at this point are Specialist Paramedics, able to take on additional responsibilities working in a multi-disciplinary team with a GP as its lead clinician.
The Dumfries and Galloway Out of Hours team also currently includes two trainee Advanced Nurse Practitioners who are on placement over the next two years, and prescribing pharmacists who are also able to work independently within the service.
Dr Desai said: “At peak times on weekends or public holidays when we know there are often a lot of medications queries and requests, we thought it would be reasonable to have a prescribing pharmacist who could tackle those things.
“But the pharmacists that we have at the moment are ones who have had some training in physical examination, and so they are dealing with some common clinical conditions in the Primary Care Centre – dealing with skin conditions, ears, throats, that kind of thing.”
Addressing the move towards a multi-disciplinary team, he added: “This would have been the way of the future anyway, but it’s just speeding things up quite a bit, and now we have the right people, with the right skills, dealing with the right patients at the right time.”
What the new GP contract will mean for Dumfries and Galloway
A NATIONAL ballot has seen Scottish GPs vote to accept a new contract – but what does it mean for Dumfries and Galloway?
The new contract is aimed at allowing general practitioners to focus their attention on providing care for the patients most in need, as responsibility for delivering services such as blood tests, repeat prescriptions and dealing with minor ailments is instead taken on by the Health and Social Care partnerships across Scotland.
Dr Grecy Bell is the region’s Associate Medical Director for Primary Care, as well as being a working GP in Annan, and she says the contract could be ‘transformational’ for Dumfries and Galloway as a new approach to services is introduced over the next three years.
Addressing the 2018 contracts, Dr Bell said: “We want to focus on patients that need us the most, people that really would benefit from our care. At the moment we feel that we are doing far too many other things that perhaps are not really providing the benefit to patients who need it the most. This contract will allow GPs to focus on what they do best, which is working with patients and their communities.”
Addressing the particular challenges in Dumfries and Galloway, Dr Bell added:
“Being a very rural area is one of the factors that we need to take into consideration when thinking about delivering the services, ensuring that GPs in Dumfries and Galloway can provide the care and support that our patients need.
“Our GP workforce in Dumfries and Galloway is getting older, and nationally we are training less GPs because we are not getting trainees to choose general practice. Meanwhile, the number of people over 65 in our region is increasing – adding to that existing GP workload.
“So we need to think about how we are going to be able to provide the service that the patients need in a way that we are able to offer extra help to the people that need it most.
“And it’s realising that there are other professionals within our Health and Social Care teams such as nurses, pharmacists and paramedics who, with support and extra training, can extend their professional remit to take on responsibilities and authority at the top of their licences.”
The decision by GPs to accept the new contract means a Primary Care Improvement Plan must be created for Dumfries and Galloway, to ensure the changes are in place in three years’ time – by 2021.
This will mean working with GPs, GP practices, other medical and social care professionals, patients and representative groups to develop the best approach for Dumfries and Galloway. It will involve looking at how and where services are delivered, but with the transformation set to take place gradually and carefully.
Dr Bell said: “We want to ensure that services are delivered as closely to GP practices as possible, but as part of the ongoing integration of health and social care we have the opportunity to work with the NHS, council and voluntary and independent sectors as partners to determine what the best options and points of delivery might be.”
Responsibilities taken over by Dumfries and Galloway Health and Social Care Partnership include:
- Repeat prescribing, and the monitoring and reviewing of prescriptions.
- Taking bloods, with nursing support being provided to practices.
- Vaccination services.
- Urgent care services including some home visits, with the potential for a greater role for paramedics as already seen in a six-month pilot scheme in the region’s Out of Hours service.
- Community treatment and care services.
- Some physiotherapy services, community mental health services and community link worker services.
The new contract developed by The Scottish Government and the British Medical Association (BMA) will standardise GP incomes and create the potential for a better work/life balance, encouraging more doctors to choose general practice.
As a GP herself, working two days a week at the Greencroft Medical Centre (South) in Annan, Dr Bell added: “We’re integrating, we’re offering support to practices, and we’re letting GPs focus on being the expert generalist.
“And this is huge change, because it’s not only a contract – it’s a vision. It’s a vision that is shared by GPs by saying yes to the contract and saying, ‘This is the vision for the future’.
“It’s transformational, because this is allowing GPs to focus on dealing with patients rather than the multiple things that we have been doing, and that is going to make the workload more manageable.”
Dr Bernard Jones is one of two GPs who staffs the Glenkens Medical Practice in New Galloway, and is also the clinical lead for the Stewartry area.
Dr Jones said: “The board will now be required to carry out health care activities which traditionally would have fallen to the GP practices. It’s something that GPs will have to get their heads round as well.
“The aim is that GPs will also take the lead in shaping how the health board delivers the other services. So it’s a different role. GPs will still be seeing patients, but it’ll be focused on those with complex needs and who have conditions which are perhaps not easily diagnosed.”
Dr Jones added: “The overarching aim of the contract is to reduce the overall workload of individual practices, which I think the contract will do – allowing GPs to concentrate primarily on being clinicians. The way work is going to be reduced is by other health board employed staff taking on tasks such as repeat prescribing and vaccinations.
“It was certainly quite a surprise for me to read in the contract that repeat prescribing, amongst other tasks would no longer be our responsibility, thinking ‘Who’s going to do this?’ However, it is not dissimilar to 2004 when the previous contract came in, and GPs were no longer obliged to do on-call work. I couldn’t believe that this would ever come to fruition. At that time I couldn’t see how that would work, but it came to pass and a new approach to providing out of hours care was adopted.
“So in the same way there are things now where one may think, ‘How will that work?’. However, it probably will come to pass, and new ways of providing primary care services will, in time, become adopted and established, although it would be unwise not to understate the challenges that lie ahead, particularly around some of the smaller, more remote practices in quite how it will pan out.”
June Watters is the Wigtownshire locality manager for Dumfries and Galloway Health and Social Care.
June said: “The new GP contract is welcomed and provides both opportunities and challenges operationally to implement.
“I think everyone is now more aware of the challenges general practice continues to face across Scotland. These are magnified across Wigtownshire due to the rurality of the area.
“Increased workload, increased risk of available staff and premises, recruitment and retention are all factors in the challenge to deliver sustainable local general practitioner services.
“General practice requires a team approach relying on clinical and non-clinical staff including medical, nursing, healthcare assistant and practice management.
“The approach we are using across Wigtownshire is to extend this core practice-based team to include additional professionals. Initially this will be pharmacy and mental health professionals and advanced nurse practitioners.
“This is in line with the new GP contract and is expected to free up GPs to enable them to focus on more complex care and provide more clinical leadership.
“As a locality manager I am now focussing on better understanding the impact of the contract on how we support the public in accessing the appropriate professional which will not always be the GP.
“At the same time I am ascertaining the numbers of professionals currently available to deliver the new services and how we continue to develop the new workforce required to enable us to deliver the support outlined in the contract to GPs within the current budgets.”
GP facts for Dumfries and Galloway
There are 33 GP practices across Dumfries and Galloway.
There are 115 full time and part time GPs across Dumfries and Galloway (April 2017)
This equates to 91.7 Whole Time Equivalent (WTE) GPs across the region.
There are approximately 150,000 people living in Dumfries and Galloway.
On average, for every 1 whole time equivalent GP there are 1670 people
In 2011 there were 23,300 people aged 0-14 years, 95,000 people aged 15-64 years and 33,000 people aged 65+ years .
By 2037 it is expected there will be 20,800 people aged 0-14 years, 72,600 people aged 15-64 years and 48,200 people aged 65+ years.
Approximately 25% of remaining GPs are aged over 55 years and could retire soon.
95% of visits to a GP practice are managed within general practice. 5% of visits result in a referral to hospital based care.