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GPs asked to prescribe drugs and chase test results for secondary care inpatients

More than one in four GPs have been asked by a secondary care provider to provide primary care services to inpatients, a Pulse survey of more than 700 GPs can reveal.

GPs said the requests were 'ridiculous' and that they are treated like 'house officers', with no one taking into account the extra workload caused by the requests.

The survey of 727 GPs found 197 (27%) had been asked to provide services to inpatients, 488 (67%) said they had not and 42 (6%) said they did not know.

GPs said they had been asked to provide services ranging from providing blood tests and removing surgical drains, to providing annual reviews to patients with coeliac disease.

A number of GPs said they they were repeatedly asked to prescribe drugs for patients that hospitals could not get hold of, set up further referrals and tests for discharged patients and to provide social care services for patients with mental health issues.

In once case, a GP was asked to prescribe eye drops for an in-patient facing delays at a hospital pharmacy.

Newham GP partner Dr Jim Lawrie said GPs in his area have been used like house officers by secondary care physicians, being asked repeatedly to do blood tests and scans for the renal team.

He said: ‘Many local GPs feel that they are organising tests and collecting results for the consultant to view on the electronic system. Some describe their status as the virtual house officer for the renal physicians.

'Whilst the local GPs want to do their best for the patients and if possible save money for the commissioning group, no account is taken of the extra work this causes for the GPs.’

A GP from Hertfordshire said primary care services carried out by GPs at their practice for in-patients included ‘managing hospital clinic's results, organising onward referrals for clinics that they should be doing themselves, picking up midwifery routine antenatal care in absence of provision by their service eg prescriptions and when midwife on leave, A&E letters often expect GP to chase results of scans and investigations'.

A locum GP from North Wales said: ‘This is part of rural practice with cottage hospitals, but sometimes we are asked to provide scripts for items the hospital pharmacy will not stock or provide, which seems ridiculous and possibly fraudulent.’

Last year the BMA said GPs were ‘likely’ to have to provide primary care services for inpatients resident at psychiatric and other specialty institutions within their practice boundary if the residents fall into the practice's geographical area or if the institution is registered as a care home by the CQC and is not registered as providing hospital services (in England).

Hospital inpatients can also fall under a practice's remit if the institution does not provide 'adequate primary medical services', with the BMA’s guidance saying that there are 'unlikely to be reasonable grounds for refusing to register such patients'.

 

Readers' comments (19)

  • GPs can say no and should not surcome to emotional blackmail. It takes two to tango.

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  • Rishabh Prasad

    Not sure what the problem is. I write back to secondary care colleagues, simply stating I'm not their house office, and for them to organize. Soon enough, they stop asking.

    If you act like a house officer, you will be treated as such!

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  • I remember being asked to do preop examination including blood tests and ecg. I telephoned and spoke to sister in charge and asked how would they fund my time . She said the hospital is far away for patients to keep coming. I said patient requested referral to you so how he travels is not my problem. I did not hear from them again

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  • IF the powers that be REALLY cared they would employ someone, only for a few sessions, to collect examples of these and fine the services involved.

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  • They seem to care much more about bouncing GP referrals

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  • There's also a systems problem.

    For instance, if you see NHS patients (through 'choose and book') at a private hospital, you have no choice but to ask the GP to prescribe. The private hospitals can't do NHS scripts. Seems rather stupid to me.

    Another issue is drug budgets, secondary providers want as much as possible of the drug cost to come out of primary care budget.

    In relation to referrals, for a long time we actively told NOT to refer directly to other departments other than for red flag symptoms. The rationale being that the primary care may not wish for the patient to be referred and they're the purchasers!

    In relation to blood tests and ultrasounds, partients often prefer these tests done closer to home and ask for them. Indeed many GPs prefer that community diagnostic services are used in preference to hospital ones (often because they're running them).

    Bottom line is that this is a very complex issue. To make out that secondary colleagues treat their primary care colleagues as some sort of subservient service does both group a great disservice.

    I personally believe that this is primarily a systems issue and many of the systems are deliberately structured to shift work into primary care. The fact that resources haven't followed is down to short-sighted policies in the DOH.

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  • Ased makes a good point- we are all subject to the pressures of people where we work telling us what to do. I do think some consultants take the P$%£, but they should be directly addressed. And work should follow activity throughout the NHS, having the GP contract as "all you can eat" is the main issue

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  • And I thought secondary care didnt refer internally because they can generate anther opd fee.silly me.

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  • I write back with a standardised note: letting them know that I expect them to organise and follow up on any tests that they deem appropriate. GPs need to stop acting like house officers.

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  • This happens regularly here...

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  • I have been asked to prescribe a patients 'usual drugs' as a GP by an inpatient psychiatric ward, despite the fact that two of the drugs were contraindicated in mania!

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  • We just say No very easy actually

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  • I have sent more than 10 letters to Consultants and Registrars telling them to seek help from Medical Directors or GMC if they have restrictions place on their prescribing and reminding them of their duty to issue as not issuing results in delays of months in initiation of treatment due to delay in letters.

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  • The BMA provide template letters for all use kind of issues. The change in the hospital contract means that these tests results and follow ups and onward referral or discharge letters should be dealt with by the hospital, contractually. It’s not our job. I’ve been sending these letters for two years now. They go to the CCG and to the LMC. Admittedly the requests still come and I’ve not heard of any action being taken.

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  • Dear All,
    I write back telling them how much the fee will be for me to carryout work they are subcontracting to me, and to confirm that they will pay, before we do it.
    Regards
    Paul C

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  • Just the time spent bouncing these letters is immense, as the risk should you not respond in a clinically appropriate way sits with us mug GPs in our messed up regulatory system.

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  • For goodness sake work to your contract and just say no, not my problem

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  • We are all busy but I think secondary care you need to read your contract and GMC advice which boils down to:
    1.If you think a patient needs a test - Request it. I'm not your secretary/junior doctor.
    2. Consultants if you feel your patient needs onward referral to another speciality- Do it. Its part of your contract and yes the hospital will bleat about spending money but until we get rid of the perversity of the internal NHS market that's life.
    3. The responsibility for chasing results and relaying their results to patients remains with the clinician who requested it. You have a secretary with a phone.
    4. You are contracted to provide your patient an ample supply medication on discharge from hospital.
    PS changing everyone who is stable and well on warfarin to a NOAC will potentially bankrupt primary cares medicines budget.
    Thank you

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  • The system is a complete bureaucratic mess with the patient stuck in the middle. The GPs are sick and tired of being treated like house officers; and secondary care view the GPs as idle and unhelpful.

    It will get a lot worse

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