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GPC calls for limit on patients seen per day in manifesto for general practice

The GPC has called for there to be a maximum limit set out for the number of patients GPs can see in a day, with excess patients seen by ’locality hubs’, as part of its action plan published today.

The call is one of a range of actions outlined in a new document outlining a plan to reduce GP workload and solve the recruitment crisis, forming part of its Urgent Prescription for General Practice campaign.

It comes ahead of the Government’s ‘roadmap for general practice’, to be released as early as next week, which will set out a range of actions to support general practice.

GPC chair Dr Chaand Nagpaul said that the document is a result of the ‘clear message’ sent by local GP leaders at the Special LMC Conference in January.

The most striking suggestion is that NHS England should set a ’national standard for a maximum number of patients that GPs, nurses and other primary care professionals can reasonably deal with during a working day to maintain delivery of a safe and high quality service’.

To manage the situation when the limit it reached, commissioners should ’establish locality hubs to which practices can refer urgent patients when they have reached the capacity threshold for safe care on any given day’, the GPC added.

Other suggestions include:

  • A national list of services that are not included in core GMS which practices can choose if they wish to provide, with pricing benchmarks nationally set that can be locally adapted according to any variations’.
  • The current CQC regulation process to be ‘replaced’ with ’targeted assessments of essential quality assurance processes where supported by evidence of risk of patient safety’.
  • An end to the ‘duplication’ of the CQC registration process and NHS England’s national performers list ’with a single slimmed down cost-effective process funded by NHS England not practices’.
  • A nationally defined employed GP contract modelled on the hospital consultant contract ’for those GPs working for other providers or GP led organisations’ in a bid to ease recruitment problems.
  • An end of inapproptiate workload shift, including ‘all hospitals’ providing ‘a dedicated GP helpline to address primary/secondary care interface problems’;
  • The introduction of 15-minute consultations
  •  A new DES for GPs to dedicate time to care home patients.

GPC chair Dr Chaand Nagpaul said the ‘important’ document ’brings together practical and deliverable ideas from GPs and sets out a comprehensive, positive and practical approach which, if adopted, would make a significant difference to both practices and patients’.

He added that the document comes in response to the ‘clear message’ sent at the Special LMC conference in January about the ’state of emergency’ in general practice.

He said: ’Fundamentally, it calls for a reversal in the decline in funding for general practice to ensure it has the resources to cope with escalating demand and provide GPs with the space and time to provide high-quality, safe patient care.

’It also proposes ways to limit workload to safe levels, manage demand, end the inappropriate bureaucratic demands on GPs and support practices with new ways of collaborative working and maximising the potential of technology.’

Legacy of the Special LMC Conference

LMC conference 2016

LMC conference 2016

The Special LMC Conference was convened following grassroots pressure regarding the crisis in GP workload.

It was kicked off by a barnstorming speech from GPC Dr Chaand Nagpaul, who said the current state of general practice was unsafe for patients.

At the meeting, GP leaders moved a step closer to a potential mass resignation should the Government fail to respond to ongoing pressures facing general practice.

The latest document - which is a result of the Special LMC Conference - comes ahead of the Government announcing its new road map for general practice.

What Jeremy Hunt’s GP rescue package really needs







Readers' comments (45)

  • There's really only one course of action that will make any difference and that's in increase in funding. Say from 7.32% to 11% of the NHS budget. A restoration of resources. All else is doing stuff to be seen to be doing something. If funding is not forthcoming it is reasonable to surmise that primary care is not wanted and is being allowed to fade away or be replaced by PUSHOFFDOC.

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  • And where will they find the GPs to man the locality hubs?

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  • As I've said before decades ago the college recommended a list size of 1200 peer wte. If there was funding for this, and you could have a decent income on 1200 patients EVERTHING would fall into place. It isn't rocket science it's a funding issue

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  • I agree something needs to happen to help control GP workload but not sure this is the answer. How do you define when a GP is 'full'?

    If you set the limit at 40 contacts per day this could easily be gamed by practices where 30 of those 40 could be follow ups, pre books and self selection by clinicians. In terms of actual patients needing help per day patients could end up never seeing their GP but instead referred to hubs. 'Oh sorry I have my 40 pts booked for today, can you jog onto the hub please...'

    Every practice/area will have a variation in GP workload and local assessment needs to happen to baseline what GP practices are delivering in terms of appts and what they can potentially deliver in terms of working differently. CCGs/Federations can then plan intelligently for the shortfall in General Practice with hubs providing this service on the days and areas required. (If required).

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  • Great ideas. Here is what will happen:

    NHSEngland admindroid will do back of sherry label calculation:

    GP surgeries open 0800-1830 daily.
    Thats 630 minutes opening time.
    GPs can do this in 10 minutes.
    Therefore the maximum number of contacts per GP per day will be set at 63.

    The RCGP will 'welcome this new NHEE initiative to limit GP workload, which now frees us up to do more boiler inspections'

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  • The suggestion that the patient numbers should be limited is completely unworkable. As a partner we are responsible for patient demand, safety, staff absences and have to see what is required in a certain day. Flexability is key to cope with staffing issues and any arbitrary limit would be counterproductive and increase further patient addition it may increase staffing costs to practices who would be forced to hire more locums on days with less doctors working. General practice is about autonomy for partners to run there own practices the best they can, I would not support such a change, this is unhelpful.

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  • Locality hubs? What was wrong with GP walk in centres? They seemed to work ok until our CCG closed them down!

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  • And I did 110 telephone triage calls/consultations and 9 face to face consultations whilst supervising our new F2. Good luck GMC on this one!

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  • It's the demographic ,stupid! We need more resources to maintain quality . pay for bronze - get bronze,mate.

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  • I need three things to help with my GP role.
    1. Increase funding.
    2. Allow surgeries to close lists if over a certain capitation (i.e. 1500 patients per WTE)
    3. Give me back up if I decide to say 'No' to an inappropriate demand on the basis of my clinical experience

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