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GPs buried under trusts' workload dump

GPs asked to help trusts cut long hospital stays by 25% before winter

NHS England has told GPs to help hospitals to reduce the number of patients who stay too long in hospital by a quarter.

Hospitals will be told they must reduce lengthy stays of hospital patients, especially those who are elderly and frail, by 25% before winter or face disciplinary measures.

Speaking at the annual NHS Confederation conference in Manchester, Simon Stevens and Ian Dalton, the chief executives of NHS England and NHS Improvement, will set out the plans which will they say will 'help to free up thousands of hospital beds and ease pressures next winter'.

But Mr Stevens said acute trusts could achieve only 'half' of the target set out by NHS England, with the rest to come from local authorities, social services and GPs.

According to NHS England, shorter stays 'will benefit patients who would otherwise be stuck in hospital when they are well enough to leave as well as freeing up beds for those who are sicker'.

It claimed many older people, especially who are frail or have dementia 'actually deteriorate while in hospital'.

NHS England said this comes as nearly 350,000 patients spend more than three weeks in hospital every year, 'many' of whom do not need to stay for medical reasons.

It aims to reduce the number of long staying patients by around a quarter, 'freeing up more than 4,000 beds in time for the winter surge'.

NHS trusts will be asked to 'close the gap' between the number of patients who are discharged during the week and at the weekend and 'make greater use of' admission alternatives such as emergency day cases.

NHS England said that hospital stays 'above the best practice guidelines' are going to be 'treated as a safety issue that urgently needs addressing with the time patients have spent on wards closely monitored through the Patient Administration System'.

Although NHS England's announcement was light on detail regarding how the target would be achieved, especially in light of dwindling social care funding, it said: 'Trusts will be supported by extended GP access and a focus on avoiding unnecessary hospital admissions including more support for care home staff to prevent residents being admitted.

'There will also be regional emergency care intensive support teams charged with helping to deliver the 25% ambition.'

And Mr Stevens told the conference: 'The fact that we have perhaps a fifth of our precious hospital beds occupied by folks who have been there for more than three weeks and are ready to go home, is an affront to patient dignity; it has consequences for our ability to admit emergency patients from A&E; and it is crowding out the ability to admit people who need routine surgery, and surgery. 

'So the top operational objective has got to be unblocking this over the course of the next year. 

'About half of that is probably in the gift of acute trusts, while half of it relies on change processes by community health services, councils, GP services. 

'So that is why for those of you who are either working in acute trusts, or community services or [as] GPs, or social care: Have a look at your own figures, see the impact that you can have, if you are able to take out a quarter of that delay and you will find that will unlock a lot the financial and operational reform that we need to deliver over the course of this year.'

Mr Dalton said: 'By setting this national ambition and working with trusts and local systems to deliver it, we will help more patients to recover safely and as quickly as possible, while ensuring that hospital resources are used for those who need them most.'

The announcement comes as last winter saw the worst-ever A&E waiting times and growing waiting lists for patients, prompting calls for urgent action by politicians and NHS leaders.

But GP leaders argued that there was no capacity in general practice to deal with the extra workload of caring for patients released earlier from hospital stays.

BMA GP Committee chair Dr Richard Vautrey said: 'Practices, and particularly community nursing teams, are struggling already with patients who have been discharged too early with complex problems.'

He also highlighted that evaluation to date of extended GP access 'did not show a significant impact on admissions as it is a different population that is being catered for'.

And he added: 'It's only with proper investment in general practice and community based services that we will be able to make the significant difference in the quality of care we all want to see... NHS England and the Government would be better to invest the recurrent funding for extended hours in to core day-time general practice as that is where the greatest need and demand is.'

Leicester, Leicestershire and Rutland LMC medical director Dr Anu Rao said she did not think NHS England was 'joining up the dots'.

She said: 'The problem is they haven't made primary care robust enough or resourced enough to be able to absorb the kind of work that they want primary care to absorb.

'The idea is good - patients shouldn't be staying long in hospital. 'However, where patients are going to come back into the community, you need to put in resources within the community to be able to do that and that's not happening. I think it's not going to work.'

RCGP chair Professor Helen Stokes-Lampard said: 'GPs and our teams work incredibly hard in challenging circumstances to deliver as many services for our patients as possible – and it is credit to them that now more than half the population has extended access to routine GP services in one form or another. 

'However, in the drive to increase this further, and more quickly than the original target, it must be remembered that patients should already be able to access GP care when they need to through routine GP services and the GP out-of-hours service.'

According to Professor Stokes-Lampard, what is neeeded is 'better public awareness of the different services available for patients, so that they know where to turn when they become ill', and she argued that GPs must 'retain the flexibility to deliver their services in the most effective way' dependent on their patient needs.

'There is absolutely no point us using our scant resources to offer services for which there is not much patient demand, simply to meet arbitrary targets. 'With the significant workforce constraints we are currently working under, extra services can only be offered by compromising existing services – either reducing the quantity or quality of core hours offerings, or both,' she said.

 

Readers' comments (26)

  • Great - more crap rushed dangerous discharges and dumps to the local nursing homes to deal with.

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  • Avoid admissions? We refer sick people in. It’s up to the consultants if they chose to admit them....

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  • In my local area, I do GP locums and also work as a local Councillor, the communications we receive about the NHSE are sometimes impenetrable. However, it is not a party political matter. There was reduction in social policies under both Governments in the past 12 years. My personal view is that hospital geriatricians should be given/take on community roles

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  • @TOTL 7:09pm

    This won't happen to the Tory members because they are wealthy, can buy their care and investments for children to keep these offspring free enough to look after them. Basically, they are detached from the world of reality of many patients we see.

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  • Cloud cuckoo land! Even suggesting this target given the current climate suggests NHSe has lost the plot and is clearly incompetent.

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  • A relevant journal I found after working in a palliative care rotation:

    "What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death"

    http://journals.sagepub.com/doi/full/10.1177/0269216317734435

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  • Took Early Retirement

    Risible.

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  • Dear Mr Stephens:

    This is the olecranon.
    This is the gluteal muscle.

    Kindly note the distinctions.

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  • Suddenly about 15 years ago the long stay geriatric beds closed and all the old people were placed in nursing homes, we were then made “community geriatricians” without being asked or funded and our geriatrician colleagues evolved into stroke physicians......
    Roll on many years and my job as a Gp has become almost full time geriatrician with increasingly complex co-morbid patients under my care, social care has collapsed, nursing homes are closing due to funding gaps, district nursing has been savagely cut and my income and resources as primary care physician have dropped by 50 per cent over the past decade,
    My list has grown, there are no locums, no new doctors coming here to primary care and nor it seems it is my responsibility to protect secondary care from bed blockers.....
    How do I do this with no resources? I could pray, I could send a letter to Santa asking for help, I could work harder?, I could ask the someone reinstate local governance in NI to oversee this task, I could cry, I could resign and walk away...... sadly this is what a lot of my more senior colleagues have had to do over the last few years
    Answer.... fund social care appropriately and treat older people with some respect please, this is my answer Mr Stephens, please listen and get the tories to stop picking on elderly vulnerable sick people and beleaguered primary care workers

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  • The broken rules means CCGs have to pay the hospitals and without extra money, GP funding has to be cut. Over the years GP workload has increased. The MDU fees has also increased with the increased risk as well as increasing regulation. We need a system overhaul. The sooner the NHS dies the better. We can then be like Australia with proper funding delivering proper services and real choices for patients. Doctors can now develop and use their full set of skills professionally and clinicians can practice without restrictions from non clinicians/pen pushers. We are already on our knees with workload and over regulation and we have no more capacity to help with no staff.

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