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Independents' Day

Not a single hospital sanctioned for GP workload 'dump', finds Pulse investigation

Exclusive Not a single CCG has enforced a contractual requirement on trusts to stop dumping work on GPs, a Pulse investigation has revealed.

As part of the GP Forward View released last year, NHS England changed trusts’ standard contract to prohibit them from sending patients back to GPs unnecessarily.

But Pulse has revealed that – despite GPs making 3,600 formal complaints to CCGs – not a single one has resulted in any kind of sanction for trusts.

Instead, the GPC said that hospitals are dumping even more workload on GPs since NHS England implemented the new measures last April.

The new measures introduced a number of changes to the NHS standard contract for trusts and other providers, including:

  • Cracking down on patients being bounced back to GPs after they failed to attend a secondary care appointment;
  • Encouraging consultant-to-consultant referrals for conditions related to the original referral;
  • Ensuring that trusts provide patients with the right information or adequate medication.

But a Pulse FOI answered in full by 93 CCGs reveals that, extrapolated across the whole of England, there have been around 3,600 complaints made by GPs about hospitals failing to carry out these contractual requirements.

The same FOI revealed that not a single CCG had taken any sanction against hospitals for failing to carry out their contractual requirements.

Dr Robert Morley, GPC contracts and regulation lead and executive secretary of Birmingham LMC, said: 'CCGs appear to have been totally impotent in being able to hold secondary care providers to account for this.’

He added that workload dump from secondary care has always been a problem, but it 'appears to be getting worse’.

NHS Bristol CCG told Pulse it had received 156 complaints from GPs and has taken no form of remedial action.

But Avon LMC chairman Dr Mark Corcoran said this was a 'gross underestimation’ of the problem.

The LMC carried out its own survey of the issue over a one-month period in November 2015 before trusts’ contractual changes, which found practices were reporting on average 42 examples of inappropriate workload being dumped on GPs by secondary care each month.

The GPC has devised template letters for GPs to use when encountering examples of workload dump.

Dr Corcoran said their letters are not yet routinely used by practices.

He added: 'GPs don’t report all these to CCGs. We have tried to send out template letters to GPs but unfortunately they don’t seem to know about them. If they did, the numbers would go up hugely.’

An NHS England spokesperson said: 'We understand the pressures on GPs and this is why we have introduced new contractual measures to help reduce bureaucracy and red tape.

'While CCGs are responsible for ensuring these requirements are met, breach notices and penalties are a last resort and so it is likely that action is being taken to resolve complaints before this stage is reached.'

The rules banning hospitals from GP workload 'dump'

The rules, first outlined with the General Practice Forward View last year, were added to the 2016/17 NHS Standard Contract for hospitals.

The GPC had asked for NHS England to review secondary care workload dump as part of its Urgent Prescription for General Practice.

The rules set a time limit for hospitals to electronically send discharge summaries to GPs, enable consultant-to-consultant referrals, requires hospitals to supply medication on discharge and require hospitals to notify patients of results of clinical investigations.

NHS England has said the rules would 'enable GPs the ability to see patients more quickly, thereby reducing the likelihood of A&E attendances and emergency admissions'.




Readers' comments (20)

  • Until our contracts change and there is a cost attached to the dumping of extra workload this will continue.....why would a CCG stop it as currently the dumping costs the CCG nothing. Only when our contracts move to a payment by activity model will this stop as the increased activity will then cost the CCG and money and money only will change behaviour.

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  • What Nish said. Absolutely spot on, the problem is the contract that allows for unfunded limitless activity.

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  • Protection from the nhs cosa nostra carries on,,,,,

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  • Azeem Majeed

    In my own general practice, my experience is that we have to contact hospitals directly if we have any issues we want to address as contacting the CCG almost invariably results in no action.

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  • yes better to send a letter directly to consultant as nil happens if contact CCG.

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  • Nish you are perfectly right. Behaviours will change only when it hits your pocket whether its hospital or patient. Its high time we also get paid by activity rather than block contract,

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  • That's because there is no such thing. 'Stop the workload dump' is one of the most destructive, paranoid and unhelpful campaigns I have come ever across.

    You are targeting the one group of people who would have been on your side, as they too are drowning under an unstoppable tide of work (not 'dumped', just work).

    Fight the cause, which is the massive gap in the NHS between funding and demand, not another group of its victims

    The Kings fund shows the massive increase in workload from the hospitals over the same period - worth a read. You are not the only ones drowning

    I agree with watchdoc - if you've a specific problem, why not just write directly to the consultant? The CCG adds nothing to this process except bad feeling and inertia on both sides

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  • The process of challenging "dumping" is itself time-consuming. This has been tried by GPs in our area but with no improvement. GPs essentially work to a block-contract with no safeguards to prevent it.

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  • Isn't this EXACTLY what NHS managers should be doing - taking the initiative, fighting clinicians' battles for them -- so that we don't have to waste our time doing it ourselves? There is no better example of why the NHS is in the mess it's in than this dreadful situation. 'We've created all these rules... but we won't police them.'

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  • Cobblers

    This is a contractual matter, is it not? Presumably the CCG has contracted for an episode of care which may, or may not, involve 'follow up'. If that follow up is then devolved to the GP then the hospital have not performed to contract. Submit an invoice to hospital finance director, copied to CCG. Ideally do not do the job of work until agreement in writing received. If clinical circumstances dictate then do the work and take the hospital to the small claims court.

    A few of those will see action methinks. Not something a GP would want to do seeing as time is of the essence but needs must people. Grow a pair.

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