Stream: A software solution to safely shift general practitioner workload to non-medical clinicians

"Almost one million patients per week are unable to access a GP appointment. This is due to increased demand for GP appointments (due to an ageing population, rising prevalence of long-term conditions, population growth and rising expectations) and reduced supply of GP availability (due to early retirement of GPs, an increased number of GPs working part time and record numbers of vacant training posts). This staffing shortfall will only get worse with 40% of GPs planning on retiring over the next five years.

Despite the British Medical Association calling for a 40% increase in GP funding (September 2017), increased funding alone will not tackle this crisis as it takes over ten years to train a GP. This project will develop AccuRx _Stream_, decision support software that will upskill nurses, pharmacists, paramedics and other practice staff to allow them to shift workload from GPs. _Stream_ will be based on AccuRx _Chain_, existing decision support software that focuses on improving antibiotic prescribing accuracy, and is used most by nurses.

_Stream_ integrates with existing GP software and provides decision support for routine conditions that can be used with the patient. By pulling data from the patient's record, patient-specific recommendations can be given without requiring extensive questioning, and a full audit trail of the consultation is automatically documented. _Stream_ also generates personalised self-care advice for the patient to take away, that is sent to their phone and printed. This evidence-based decision support allows allied health professionals to safely and confidently manage consultations that they could not previously. Consultations that _Stream_ will support include minor ailments, chronic disease management, contraception, diagnostic services, infections and lifestyle advice.

By upskilling allied health professionals, _Stream_ provides new opportunities for career progression, increasing retention and morale of the entire practice team. Relieving practice pressure will also help reduce burnout and early retirement of GP partners.

Shifting workload from GPs will not only relieve workforce pressure and reduce costs to primary care, but will also reduce pressure on the wider health system. For example, patients unable to book a GP appointment are more likely to attend A&E, practices with insufficient resources are more likely to refer patients unnecessarily for hospital care, and patients with poorly managed chronic conditions are more likely to be admitted to hospital. Increasing access to primary care by reducing waiting lists will also help to reduce health inequities."