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GPs: Free up 3m appointments by ending hospital workload dump

by Costanza Pearce
4 September 2020

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Ending inappropriate transfers of workload from secondary care could free up 3m GP appointments across England, according to a report produced by a group of GPs.

In a survey of 112 GP practices covering 1.2m patients, Kent LMC found that 1,037 episodes of workload transfer had occurred over 10 working days in July.

While in some practices, individual GPs ‘opportunistically’ recorded episodes, two local practices covering over 35,000 patients used specially-trained administrative staff to review all incoming communication.

They reported 123 episodes of workload transfer, which the LMC said was ‘as close as possible’ to an accurate reflection of every single episode during the study period.

Extrapolating these results across England, the LMC has estimated that 5m episodes of workload transfer occur each year, taking on average approximately 10 minutes of GP time and 20 minutes of administrative time to resolve.

It comes as throughout the Covid-19 pandemic, GPs have warned that they are managing more patients ‘outside their comfort zone’ due to less support from secondary care services.

And one LMC last month warned NHS England that its local hospital has ‘closed its doors to patients’.

The report from Kent LMC said: ‘If considered in working time it would require 16.5 full-time GPs to manage this workload in Kent. England-wide removing this work would free up 480 whole-time-equivalent GPs. 

‘As the average full-time GP offers approximately 135 appointments per week this could free up time for 3m additional patient slots.’

It added that the cost to general practice in England is £130m in GP time alone, rising to £190m when admin staff time is included.

Kent LMC said the recent move towards more remote working due to coronavirus had ‘accelerated the workload shift’, with guidance and contractual requirements ‘often ignored when devising new ways of working’.

The 2016 NHS Standard Contract – which mandated that onward referrals relating directly to the same condition should be managed by the secondary care specialist and not passed back to the GP – is being ‘widely ignored’, the LMC claimed.

The report said: ‘This survey [demonstrates] that the NHS Standard Contract and the campaign to reduce workload transfer into primary care are failing to impact on the overall quantity of demand. 

‘The strain on general practice in terms of workload and cost is substantial.’

Essex LMC conducted a similar survey in 2020, finding that 96% of local practices felt the volume of workload shift was ‘increasing’ and 83% felt it was ‘affecting their ability to provide basic primary care to patients’, the report added.

Kent LMC recommends the ‘elimination’ of workload transfers by classing them as patient safety ‘never events’ or the ‘incentivisation’ of secondary care compliance with the Standard Contract.

It called on regulators to consider the ‘mitigating circumstances’ when GPs are acting outside their normal scope of practice due to workload dumping from secondary care.

The LMC has moved to protect practices from workload shift by producing a set of Covid recovery ‘principles’ (see box).

Last year, an investigation by Management in Practice’s sister title, Pulse, found that nearly half (45%) of patients who don’t show up to their first hospital appointment are immediately discharged back to their GP, amid reports that 2016’s measures had failed to protect GPs.

Meanwhile, NHS England last month encouraged GP practices to ‘keep patients away from hospital’, despite recent messages to restart routine care.

And health secretary Matt Hancock signalled that he wants GPs to continue to consult patients who would typically be seen in secondary care – with specialist help – after the Covid-19 pandemic comes to an end.

Kent LMC’s Covid principles

  • LMCs must approve ‘any shift of workload’ to practices as they are under ‘unprecedented pressure’;
  • Workload shifts must be ‘adequately and safely resourced and funded’;
  • LMCs must give ‘explicit agreement’ for any changes to clinical services and pathways that impact practices, following an ‘impact assessment’;
  • ‘All actions’ originating from remote consultations must not be referred to general practice unless with explicit LMC agreement;
  • Secondary care providers must either accept referrals or agree any ‘redirection’ with the patient’s GP;
  • Practices should only resume services up to ‘safe workload limits’ – as defined by the BMA.  

Source: Kent LMC

A version of this story was first published by our sister title Pulse.