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GPs buried under trusts' workload dump

GPs write to CCG to say they are stopping all 'unfunded' work

Exclusive GPs in Lincolnshire will stop offering non-essential services they not commissioned to provide unless they are given the cash to do so under a new LMC-led campaign, Pulse can reveal.

Around 100 practices in the area have drafted letters to CCGs notifying them of their intention to stop offering unfunded services, which could see them stop providing treatments such as ear care, ECGs and 24 hour blood pressure monitoring.

It comes as Dr Chaand Nagpaul identified the withdrawal of non-contractual work as a potential legal form of action that practices can take to reduce their workload in an email to practices, as Pulse exclusively revealed. 

Lincolnshire LMC's move represents the first reported example of an LMC going ahead with this organised form of action.

The LMC told Pulse it was currently in discussions with the CCGs in the county about the proposals, and hoped to resolve the issue by March 2017.

The LMC's members originally voted in favour of taking the action in February. It came in response to the Special LMCs Conference in January, which first mooted the possibility of GPs signing undated resignationsa move recently shot down by the GPC.

GPs in the region indicated they would not be willing to submit resignations, so the LMC proposed for members to stop doing unfunded work as a means of highlighting the pressure GPs were under.

Dr Kieran Sharrock, medical director of Lincolnshire LMC, told Pulse: ‘Our practices were feeling the pinch. We arranged a meeting in February to find out what sort of industrial action they wanted to take.

‘They didn’t want to strike or sign a mass resignation letter because they didn’t want to take any action which could harm patient care so they decided that they would look to stop offering non funded extra services.’

He added: ‘Staff felt that they shouldn’t be offering these services if they haven’t been commissioned to do so and wanted to ask commissioners to find alternatives. They don’t want to withdraw services but they cannot do everything.’

Dr Sharrock said that these services were already being commissioned elsewhere in the county, but that some GPs had been offering the services to benefit patients without being commissioned.

He added: ‘The ideal situation would be that the practices get commissioned to provide the services themselves because that would be better for patients. The GPC has been pushing for practices to refuse to do unfunded work. Most of the stuff which we are not being funded for should be funded – it is in other areas. These services should be standard across the country.’

Gary James, accountable officer of NHS Lincolnshire East CCG, said: ‘As CCGs we are talking with our member practices and the LMC in an effort to address practices’ concerns and find suitable solutions.

‘This may take time to work through, however, patient safety is always our first priority and we want our GPs to be able to continue to offer Lincolnshire patients a safe and high quality service.’

CGs with large deficits have been looking to cut local enhanced services offered by GPs in a bid to save cash.

Pulse found that three CCGs rated ‘inadequate’, NHS Kernow, NHS Walsall and NHS Shropshire were reviewing enhanced services in order to save extra cash this year.

Readers' comments (36)

  • Refer all patients with chest pains and palpitations to A&E"? ...I thought that was standard procedure these days.

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  • I would think ear wax clearance was firmly the job of someone in general practice.
    But never mind as a retired GP still owning my syringe, Noot's tank and protective cape I am prepared to set myself up as "Dr Cerumen" Shall we say 50 guineas a lughole on a no win no fee basis? I am just wondering what my superhero uniform should be.

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  • I've been a GP for over 10 years , and did 6 months ENT SHO and the number of times in my life I've syringed an ear ?? ZEdRO.

    No one is telling me that is "core" GP work. It just ain't.

    Happy to do it if someone wants to pay on top of GMS core - i'll consider it

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  • Isn't it about time the contract was made totally explicit? There should not be any 'grey areas'. Yet, over the years there have often been queries about what is and is not funded. I cannot imagine may other professions that tolerate such a lack of clarity.
    When we employ staff, their contracts are legally binding on both parties and CQC would jump all over us if they were vague and unclear. Yet the GP Contract continues to be ambivalent at best.

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  • sadly the present perverted nhs regime is one of nhs bodies desperately and cynically trying to eat each other to try and keep themselves from starving...rather than cooperating in an integrated manner..most of them have been nibbling at GP land for years..the only way is to join federations and refuse to do what we are not paid to do or find someone else.
    what a disastrous mess conservative health policy has caused..what a national disgrace they are.
    support nhs reinstatement bill.

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  • AlanAlmond

    Step out of the politically correct bubble and your post is moderated and the very idea erased. Truely we live in fascist times. 1984 came true.

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  • Edoardo Cervoni

    I read with some interest the NEJM papers to be then left perplexed.
    It is sometimes worrisome observing that papers such as this one are published triggering astonishing attention and general public expectations - intentionally. It has been known for quite some time that calcitonin gene-related peptide (CGRP) is a very potent vasodilator and plays an important role in the initiation, progression and maintenance of hypertension. It is therefore to say at the least naïve to think that, dealing with attacks prevention for a condition lasting most part of the adult life, may not be consequential in terms of blood pressure and cardiovascular risks. I remain puzzled by why data addressing cardiovascular parameters have not been published in detail. Furthermore, not all the subjects responded to the treatment at all. This may well mean that when speaking about migraine, we may be putting under the same umbrella apples and pears, that is same outcome (headache), but different mechanisms (partially, or entirely). Another interesting aspects would be the one of improvement of quality of life being experienced by the patients. I noted with interest a remarkable placebo effect in the 3rd study arm.

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  • What you say is correct, but you underestimate our pharmacy friends. Sudden onset especially in a young person usually means psychological. They can easily decline prescribing sildenafil until after investigated. Giving 1 packet of 4 x 50mg sildenafil is unlikely to do too mach harm. I used to always recommend fasting lipids & glucose check and anyone over 50 a PSA. It is far better for a qualified pharmacist to prescribe than someone to buy on the internet a totally unknown product with little or no guidance.

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  • There is no mention of GP involvement in this study. I see no reason why these measures could not be initiated by the rheumatology nurse practioner. Why waste more GP appointments in a futile effort to get fat people to lose weight. They rarely do

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  • We need a national visiting service staffed by locum GPs - they will charge the NHS the right rate :)

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