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GPs go forth

80% of GPs spend more time inputting information from secondary care

Exclusive Almost eight out of 10 GPs are spending more time each day on inputting data received from secondary care, compared with last year, with some finding they have to spend up to an hour a day recording communications.

A Pulse survey of 453 GP found 79% said they had noticed an increase in the amount of time they spent inputting information frrom secondary care over the past 12 months, while only 10% said they had not and 11% didn’t know.

Asked to give an estimate of how much extra time they are now spending compared to 12 months ago, many GPs said it was taking up to an hour extra each day.

GP leaders said that practices are receiving large amounts of information from hospitals that are not coded properly.

The survey results have further underlined the extent of workload pressure that GPs are under, raising new questions about GPs’ ability to reduce pressure on hospitals and emergency services.

Dr Soong Yap, a GP in Birmingham, said he was spending ‘an extra 3-4 hours a week’ just to chase clarification or instructions from secondary care, while an Essex GP, who preferred to remain anonymous, said the hospital ‘seems to think I am their house officer’.

GPC deputy chair Dr Richard Vautrey said: ‘I think what is happening is that there are more people being seen in secondary care with information needing to be recorded [by their GP] not only for QOF but for other purposes. But also previously they might have just made a note of the letter and now they extract information from a letter and record it on a system. One of the problems is that practices are still receiving large volumes of paper that is not coded properly, or the key bits of information are not so obvious. So it takes time for practices to extract that information.’

To help reduce the workload on GPs from inputting data, ensuring greater standardisation across primary and secondary care will be necessary, he added.

He said: ‘I think one of the things that we need to see is a greater standardisation of information recorded in primary and secondary care, so that the information relevant to the patient and the health service as a whole is recorded in the same way so that it is easy to extract that information. When, ideally, information is extracted electronically from hospital to practices - or the other way around - then we will not need to spend a large amount of time extracting data from letters.’

It comes as a King’s Fund report last year concluded that GPs were hindered from coordinating care of their patients due to their ‘intense’ workloads and last month a Pulse survey showed that one in seven GPs was planning to refuse to take up the unplanned admissions DES - focused on coordinating care for the most vulnerable patients - due to not coping with workloads.

Survey results in full

Have you noticed an increase in the amount of time your practice spends inputting information from secondary care over the past 12 months?

Yes: 79%

No: 10%

Don’t know: 11%

About the survey: Pulse launched this survey of readers on 15 April 2014, collating responses using the SurveyMonkey tool. The 25 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to readers via our website and email newsletters, with a prize draw for a Samsung HD TV as an incentive to complete the survey. As part of the survey, respondents were asked to specify their job title. A small number of non-GPs were screened out to analyse the results for this question. This question was answered by 453 GPs.


Readers' comments (10)

  • totally agree - even the amount of correspondance has gone up x 3 last 5 years i would say and much of the discharge info is of poor quality

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  • This is such a significant issue now that pertains to workload pressure. "please check renal function, LFTs, pedal pulses, sugar levels GCS in 2 weeks as pt has left hospital with renal failure, heart failure, claudication, diabetic coma (which we can't be bothered to deal with)"," please arrange social & palliative care services, soft bedded mattresses, community intensivist and 2hrly bp and pulse checks " (because we can't be bothered to deal with),"please start pt on drug a,b,c- all of which cost the earth, some that are not licensed and all of you will have no experience in prescribing (but we can't be bothered to deal with). As fellow peers I think they way a lot of secondary care doctors treat GPs is scandalous and embarrassingly demeaning. If we refer a patient - the patient and us as GPs expect a 2ndry care service ( for which they receive a substantive payment ) which is of at least a measure of some basic quality that implies you actual care for the patient through the totality of there journey- no matter how long or short that may be. In all the above scenarios and much more, as a patient I would refused to be discharged till the hospital team whose care I was under satisfactorily discharged me safely and in good health. The current hospital mantra of discharge, discharge, discharge asap is putting more and more lives at risk. I am sure every GP has a tale to tell of someone clearly discharged too early but given a list of instructions to the GP from the hospital team in acknowledgement of the fact that they themselves are aware of this fact- and hence are culpable. In no other walk of life would people except this practice - I would not go to see a dentist and expect to be told after a difficult tooth extraction to take a list instructions to a hygienist to do x,y z in the probable case of complications. I would expect them to follow me up till issues were resolved. This I feel is the crux of the workload pressure debate. GPs continue to except more and more requests from secondary care in the pretext of continuity care when in fact all that is happening is they are passing the buck. Case in point, I cannot believe how may patients post tonsillectomy seem to acquire significant and severe infections usually ending up requiring iv abxs, but are almost always told to go to GP despite this being a common post op complication which the surgical team should have a responsibility for managing, otherwise how will they learn that they need to improve their practice to avoid such complications in the future.
    Things definitely need to change.

    Disillusioned GP Partner (1yr)

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  • 1:50

    Speaking from secondary care I have to acknowledge that what you say strikes a chord. The reasons behind it however, are not laziness, but reflect the relentless, dangerous and unsustainable drive to discharge the minute the patient is not hooked up to a life-support machine.

    Much of this pressure comes from government and the CCGs, using the nonsense mantra of 'care closer to home' to cut investment in the hospital (often leaving the patient with no care at all). You say the hospital receives a substantive payment. Are you aware that, for every emergency admission or elective procedure over a baseline that gets reduced annually (15% this year), the Trust actually only gets paid 30% of tariff - nowhere near even the cost-price of treatment. More than 60% of Trusts are now in financial deficit as a result.

    We have also closed too many hospital beds. This causes a log jam so that if the patients don't go home, there is no room for elective care and tomorrow's emergency admissions. The daily pressure to achieve discharge targets is terrifying for both staff and patients.

    But at the moment, your GP leaders are still shouting that in primary care 'everything you can do we can do better' and this is the inevitable result. We need more hospital beds - Simon Stevens suggestion that smaller local hospitals could provide this is entirely sensible - but I can't see it happening any time soon...

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  • Smaller local hospitals with Gp's doing ward rounds no doubt .

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  • The deluge of requests from secondary care exposes the absurd open ended nature of the GP contract which is no longer fit for purpose. There is literally no limit to what secondary care can ask us to do so it's no great surprise that they treat us as like a skivvy because our time is perceived as cheap (or fee). 'Dear doctor please refer on' is a favourite which usually results in delay whilst we try an work out what the hospital doctor actually wants the referral for. This practice is dangerous and need to be stopped. I have my own clinics to manage and patients are now waiting two weeks for a simple GP appointment. We need to say a collective no.

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  • We have reached the limit of what can be delegated to General Practice. This is due to the finite capacity of General Practice, despite what the Government believes.

    Anymore work and General Practice will fall over and be of no use to anyone. Once it goes it will be hard to resurrect.

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  • There is also a lack of understanding among patients, secondary car colleagues and the government that all this is extra to face to face contact.
    Clare Gerada's plan for a fee per 1000 consultations will not resolve this.

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  • At a recent meeting that I attended it was stated that 30% of patients admitted to the local DGH shouldnt be there and that they would be better treated in the community. I pointed out that GPs dont admit for the fun of it but because there os no alternative. They imagine that somehow this 30% of patients will be kept at home and they plan to reduce hospital beds further. At the same time local fottage hospitals plan to reduce beds. How on earth they imagine GPs can continue absorbing extra work with no extra resources is beyond me. The 2004 contract was meant to be " no extra work with out extra resources" God help GP because no one else is.

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  • The 2004 contract is now 10 years old i.e. past its sell-by date.

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  • The NHS is so disjointed!!! If only the government could devise a structure where primary and secondary care actually work together in the interests of the patient rather than devising structures which push them further apart. Both services clearly have their own issues and both are blaming each other simply because they havent been empowered to work together. Integration is a word that's been banded about quite alot but all it's actually doing is creating another bariier between the two services. I actually think that they should scrap the idea of primary and secondary care and have one organisation responsible for running both. Could call it a health authority!

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