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CCGs must include specifications on reducing GP workloads into hospital contracts, says Nagpaul

Commissioners must set up much clearer service contracts with providers to stop the ‘avalanche’ of unfunded work being transferred to primary care, according to the chair of the GPC.

Dr Chaand Nagpaul called on every CCG to create service specifications that included strict measures such as a ban on hospitals asking patients to see their GP for a re-referral after failing to attend an outpatient appointment and mandating every Med 3 discharge to cover a patient’s full recovery.

Speaking at the Pulse Live conference, Dr Nagpaul said he had written to CCG leaders urging them to support GP practices whose workload was so unsustainable they were putting themselves at risk of not providing core care with the continuing transfer of work.

Dr Nagpaul said he was telling CCG leaders that their job ‘needs to be about supporting GPs, practices and putting an end to this unresourced workload shift’.

He told delegates: ‘Some of this is not just the work, it’s work that is really outside a GP’s competence – GPs are prescribing drugs we shouldn’t and providing treatments we’re not to competent to because we’re faced with the patient.’

He added: ‘There are things CCGs can do to put an end to this avalanche of unresourced work.’

Dr Nagpaul cautioned GPs over signing up for co-commissioning, warning they could end up ‘at the mercy’ of local contracts that may allow them to drop the QOF but mean working harder for the same pay – without the GPC to stand up for them.

He said: ‘In a local contract, who would GPs turn to? You would have to be very confident in the relationship with your CCG.’

Asked about the impact of the 2004 contract on the current loss of partners, Dr Nagpaul also admitted that some of the problems general practice now faces related to ‘the way the 2004 GP contract was implemented’.

He said: ‘I think the implementation of the 2004 contract didn’t go as planned. You’ll remember the slogan was “no new work without pay” and we’ve seen the opposite. We had an era where many partnerships didn’t value taking on new partners and we saw a salaried GP workforce that then took on a function that wasn’t the same as the partnership

‘I very much believe in the partnership ethos. I believe doctors working in a collective whole, with equal status, is the best way to achieve the best productivity in a group practice. That way of partners employing salaried GPs “to do the work” is something I would regret and some practices may have done so.’



Readers' comments (7)

  • You have the right diagnosis - do you have right medicine?

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  • This will help but these work are but the biggest problems in primary care.

    Personally (and I'm sure many patients on this professionals only website will shoot me down), it's the unrealistic expectations from public on NHS.

    I regularly see
    1. I just want to make sure my child who had temp lay night but ok today didn't need antibiotic
    2. Benefit office told me to get sick note doc
    3. I'm too upset (but with no clinical symptom of psychiatric disease) to work. I just need a few weeks off. Counseling/anti depressant? No, I'll not that bad, I'm sure I'll get better by myself
    4. I can't work - I'm alcoholic/drug addict
    5. I've read on daily mail/channel 5/internet I might have (insert the name of disease here)
    6. I want a referral. I don't care what you say, you are only a GP.
    7. I want a scan (see above)
    8. My gran had this disease. I think...(see above again)
    9. I had an accident. My insurance company said I should attend just in case
    10. Could you just sign this form/write letter
    11. NH111/AED/ambulance said I should come immediately to see my own GP.
    12. My work said I need to see my doctor for sick note.

    And these are just very common stuff!

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  • I agree with I lot I have heard from this interview today, but if Dr Nagpaul has written to CCG leaders with a list of things that could be done to reduce our workload, why does this not get implemented? I don't think this will solve the whole problem but any improvement will be a bonus in the current circunstances. I don't really get why does the message takes so long to get to the right people!

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  • Nice idea but it will just be ignored like it is now. I have been reporting to the PCT/CCG for years that consultants are ignoring contracted arrangements over prescribing - falls on deaf ears.

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  • LMCs are impotent and at a local level lick boots of NHSE trying to stay in good books. Same goes for CCGs who are aware of LMCs being weak and their own weakness too. So CCGs give a hoot to what LMCs say and both CCGs and LMCs try to cuddle up to NHSE so they can experience the warmth of a good working relation. So general practice is stuffed any way you see it.

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  • 'LMCs are impotent and at a local level lick boots of NHSE trying to stay in good books.'

    That depends upon the LMC - some are actively pushing back as much unfunded work as possible due to the sheer bloody-mindedness and willingness to say 'no' of their members.

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  • Acute trust managers will start berating consultants for having a follow up rate that is too low as the contract has changed...

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