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Practices facing unsustainable pressure as hospitals 'dump' work on GPs, Londonwide LMCs' largest-ever survey finds

Exclusive: Hospitals are routinely ‘dumping’ work in primary care and piling pressure on GPs, with practices spending an average of 10 hours each week chasing up referrals and discharges, according to a major new survey of GPs in London.

The overwhelming majority of GPs who responded to Londonwide LMCs’ largest-ever survey, obtained exclusively by Pulse, said they believe their daily workload is no longer manageable, with many warning that overflow from secondary care - coupled with a ‘box-ticking’ culture of bureaucracy - is contributing to GP burnout.

The crisis will result in GPs ‘voting with their feet’ and quitting the profession unless the problem is addressed, the chief executive of Londonwide LMCs warned.

The survey findings follow Pulse’s report earlier this week that practices across the country are being put under increased pressure as CCGs block hospital
consultants from referring internally for non-urgent conditions and send patients back to their GP to save money.

The poll of 666 GPs in the capital found that 96% believed the extra GP appointments required to re-refer patients who miss hospital appointments ‘causes additional bureaucracy’.

The survey also found:

- 90% of respondents have patients coming to them within five days of hospital discharge with ‘poor or no clinical information’

- 60% of respondents believe some patients are discharged from hospital too soon

- 59% of respondents have seen patients discharged from hospital with insufficient medication

When asked how much time their practice team spends following up referrals and

discharge information in an average week, the average of the responses given was 10 hours. Some 22% of respondents said practice staff typically spend more than 16 hours each week chasing up information from secondary care.

Workload related to poor communication from secondary care was one of the principal causes of increasing pressure on general practice, the Londonwide LMCs analysis found, with other factors a rise in administration and bureaucracy, mounting patient demand and a lack of resources.

Some 86% of GPs disagreed with the statement ‘I feel my daily workload is manageable’, while 83% said they thought their current workload was ‘unsustainable’. Nine out of ten said their practices were understaffed but felt they could not afford to recruit.

One GP commented: ‘I dislike admitting this and historically I have been able to soak up whatever was demanded from me - I have thoroughly enjoyed my career as a GP, I enjoy my contact with patients. But the current demands of boxes to tick and non-patient-facing tasks is overwhelming and ultimately unmanageable.’

Another added: ‘There is so much more administrative work and more and more meetings to attend, that it seems less time is available for patient care.’

Londonwide LMCs chief executive Dr Michelle Drage told Pulse: ‘GPs will walk. There´s a risk of people throwing the towel in at retirement and before and the system becoming totally unworkable.’

She added that hospital behaviours such as failure to provide adequate discharge information were having a ‘huge impact’ on primary care.

She said: ‘Discharge summaries are few and far between - and bad when they are. Dumping of prescribing is frequent and frustrating. What this says to me is that people need to stop commissioning for secondary care and commission for primary care.’

Readers' comments (10)

  • I particularly like the discharge which says "GP to chase result". In fact I once had had a letter which said "MI caused by anaemia, GP to investigate cause". Junior grades in hospital are now brought up thinking we are their secretary now.

    I now write back and politely decline to be their scivvy.

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  • This kind of article is so unnecessarily divisive. All hospitals would be able to cite an equally large number of areas where appalling standards of care and communication from GPs make their work harder. I could give some sporting examples. But we're just dancing to the government's tune.

    Infighting is what they want, to distract us from the real issues, which is that we all are working under intolerable pressures, in an underfunded, insanely bureaucratic system.

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  • Is it not high time that we defined safe working both in hours and patients seen for every doctor. What about staff : patient ratios in A+E , GP and all other specialities.
    Lack of such ratios is the reason for Mid - Staffs and other tragedies. Be clear as to what are acceptable to function properly. Otherwise, we have this scenario where everyone works at least twice as hard, putting their own well being at stake in mental and physical health, prone to mistakes, to be accused of providing poor care.

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  • The problem is that (in general), hospitals get paid for the activity that they undertake. Of course, there are many doctors who give a lot more than they are paid for in hospital, but it is essentially a fee per item system.

    GP on the other hand is an unlimited buffet - single payment and as much activity as can be squeezed in. Due to all of the government cuts, we should really only undertake activity as specified by our contracts - ie no removal of stitches, phlebotomy, etc etc etc It's the only way we'll survive.

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  • Comments like that above just show how little we understand the problems each of us face. Hospital funding is nothing like as simplistic as you suggest. We only get paid 20% of tariff for activity above the plan, meaning we run services at a loss, but can't turn anyone away. When we run out of beds we get fined hundreds of thousands of pounds by the ambulance trusts for keeping patients waiting, but also get fined yet more vast sums by the CCG for not getting the bed base down and not meeting the four hour targets in ED. We get fined for not reducing new to follow up ratios, but criticised for dumping work. We can't refer patients without permission, but likewise get criticised for having to ask the GPs to do it. Then we get slated by the CQC, Monitor and the media because in the end, standards of care fall under these types of pressures, and by the government for getting into debt.

    Primary care undoubtedly has similar pressures to these, but it doesn't help if we fight amongst ourselves. We really are all in the same boat.

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  • More reason to look at a whole systems approach to the delivery of health care ensuring primary or secondary care receive adequate resource and funding to maintain quality and safety in all service provision. The Vale of York CCG of which we are a member is addressing many areas of collaborative working without de-stabilising local hospitals. Any visible outcome is not going to happen overnight.

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  • There needs to be a culture change.

    Lets not hide behind work pressure for poor clinical care and poor administration. It costs no money or time to ensure proper communication and accountability exists.

    I'm quite happy for consultants to tell me where I'm going wrong. I'm afraid it never works the other way as many of them seem to feel superior to GP. I'm not trying to start a fight - I have enough consultant friends to know this.

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  • Simple solution would to be to have an integrated strategic group set up with representatives from primary and secondary care with the single objective of addressing any issues arising such as those in this article.

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  • MONEY is root of all evil. ccg given limited budget to fulfill unlimited demands, they try to deprive secondary care of cash to save money. secondary care can not handle unlimited demand either.
    i say spend as much as necessary for patients both in primary care and secondary care. at the end of it all blame will go to ccg /hospital mangers/medical directors. replace them next year and story will go on and on then there would be labour government and cycle will repeat til some will say
    "we can not afford nhs in this form". he/she will lose job for saying so but it is true.

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  • research shows hospitals are dumping work on GPs.... no sh*t Sherlock! How many litres of midnight oil were burnt to distil that unsuspected and obscure gem?

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