GPs have raised doubts about the new alert systems being used in some areas to report pressures in general practice, which in their current form seem to be of ‘very little value’.
LMCs have been leading the development of the General Practice Alert State (GPAS) with the aim of escalating ‘black status’ reports to NHS leaders.
This would be equivalent to OPEL level 4 in hospitals – a situation when pressure means organisations are unable to deliver comprehensive care and patient safety may be compromised.
But GPs in areas where the alert system has been implemented have said it does not seem to work as expected, with no changes being implemented as a result of declaring a ‘black alert’ and some practices being reluctant to report they are struggling because of a lack of support.
In Lancashire and Cumbria, LMCs chief executive Peter Higgins said that the ICB ran a ‘sitrep’ for every practice, but practices either didn’t respond or were reluctant to say they were struggling.
He said: ‘Part of their reasoning was that no one did anything to help anyway and they were concerned about contract sanctions or CQC attention.
‘During the worst of the Covid and respiratory spike only one practice out of 300 declared red and two amber.
‘So everyone thought that primary care was coping and kept shovelling the work across. We have now introduced a simple anonymous system and over half of practices are now declared red or amber. They now see there is a problem.’
Lancashire and South Cumbria ICB said it now has a primary care situation report, which ‘offers a route for practices to escalate and notify the ICB of issues, request support, and inform the ICB of the pressures being faced by practices to inform decision making.’
In Lincolnshire, the LMC has administered GP practice reporting since May last year, with practice managers asked to anonymously submit activity and status data each week based on their Monday experience only. The LMC then collates data by ICB locality and shares with practices and the ICB.
Dr Stephen Savory, a GP partner in Lincolnshire who is also chair of the LMC but is speaking in a personal capacity, said his practice declared a ‘black alert’ on different occasions in recent weeks but that ‘nothing changes as a result of that reporting.’
He said he was not aware of any local practices receiving an ICB contact or clinical support as a result of GPAS reporting.
He said: ‘Our recently-departed ICB locality manager told my practice manager that she didn’t receive the data from the ICB. One ICB leader describes GPAS data in its current form as of “very little added value”.
‘I’m not aware that NHS Lincolnshire ICB currently supports payment protection for QOF or enhanced services for practices or a wider system in under pressure. It appears to be toeing the NHSE line regarding QOF suspension.
‘GP frogs continue to permit themselves to be boiled, whilst NHS managers walk away from the stove – however high the GPAS dial is turned up.’
It is understood that practice response rates in Lincolnshire have recently been around 40%, meaning that more than half of the practices do not submit GPAS data to the LMC.
Dr Savory said: ‘I understand the LMC will be contacting some practices to understand why they don’t report, and why some consistently report green in the face of routine national demand overload.
‘Are they wary that reporting pressures invites scrutiny from ICB or CQC? Has some part of general practice normalised volume overload and unsafe working?’
Lincolnshire ICB declined to comment on the system.
Meanwhile, London-wide LMCs are in the early stages of rolling out GPAS and are currently looking to onboard more practices, after piloting the system in Waltham Forest.
A spokesperson for the LMCs said: ‘I think with only the pilot and early-adopter practices providing returns we don’t currently have the size of dataset that allows us to go to commissioners and say they should be taking account of what it shows.’
The GPAS system was pioneered in Devon, where the LMC has been collecting data for the past two years.
Devon LMC agreed a pilot with the ICS to assess how to respond when practices are under ‘severe’, ‘extreme’ or ‘intolerable’ pressure.
Measures considered in Devon include suspension of routine appointments and reviews, a shift to telephone triage, remote consultations for most primary care, suspension of non-core work and QOF and closure of some practices with care delivered through additional capacity at shared hubs.