The BMA has published safe-working guidance for GP practices, which it has warned could lead to a ‘fall’ in appointment availability and some patients having to be seen elsewhere.
The advice, updated last week, includes ‘ceasing’ ‘all non-contractual work’ so all resources are diverted to core services.
The BMA’s GP Committee England (GPCE) said the guide comes as ‘GPs and practices are seeing nearly half the of the country’s population every month’. Its aim is to empower help practices to take control of workload, as well as ‘regain and retain their sense of agency, self-determination, and autonomy’ so they can deliver safe, high quality care to patients and prevent burnout among GPs and staff.
Advice reiterates guidance to move to 15-minute appointments to ‘help reduce the need for multiple repeat appointments and support continuity of care’; limit patient contacts per GP to 25 per day; and set up patient ‘waiting lists’ (see box below on managing appointments).
The guide advises practices to improve the recording of their workload, since NHS England measures based on appointment data are ‘incomplete’. Surgeries should undertake a period of manual recording of patient contacts via appointment books over a two to three day-period and include counting ‘even brief and informal types of contact’, such as calling about results.
And they should consider closing practice lists if they have reached the limit of their workforce capacity, to safeguard the care of existing patients.
The GPCE said: ‘By introducing the BMA’s Safeworking Guidance: a handbook for general practice, some practices may see a fall in the number of offered appointments each day. This could mean that patients with non-urgent problems may have to wait longer, but the priority is to ensure that all patients that are seen receive safe care within your finite capacity to provide this.
‘There will be times when patients will need to be directed to appropriate alternative services. Overall, the steps we outline will allow practices to devote their resources to those patients they are best placed to help.’
According to GPCE, the guide is ‘designed to help GP practices make decisions that will allow them to prioritise their limited capacity to deliver safe, high-quality care’ but added that decisions will need to be tailored to the needs of the patients and practice.
Outlining how workload has risen while funding remained limited, BMA said the ‘present crisis’ is now ‘so severe that GPC England strongly recommends practices take urgent action to preserve their ability to deliver safe, high quality patient care and to protect the wellbeing of their practice teams’.
‘GPC England encourages all LMCs to promote and support practices in their implementation of the BMA Safe Working Guidance,’ it added.
LMCs should consider setting up OPEL black alert systems, the guide added; while GPs should stop participating in advice and guidance as per the options outlined in the menu for collective action.
Collective action began on 1 August after GP partners voted in favour of taking action in protest over contractual terms and funding.
To manage appointments, the BMA recommends:
- Offering appointments 15 minutes in length (applies to all GPs, including locums and and clinical staff undertaking consultations).
- No more than 3 hours out of each 4 hour 10 min session should be spent consulting (applies to all GPs, including locums and and clinical staff undertaking consultations).
- Signposting to other services in the system once capacity reached.
- There should be safety net plans for urgent cases – such as, signposting/urgent slots/duty doctor.
- Routine appointments may need a wait list if capacity is reached.
- Communicating systems to patients, outlining steps should their condition change with clear safety nettingUse the whole practice team.
- Reviewing your appointment setup if it is regularly running over.
Source: BMA
A version of this article was first published by our sister title Pulse
