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GPs buried under trusts' workload dump

​Council's drastic public health cuts will leave GPs 'unable to cope'

Severe cuts across the board to public health services proposed by a Midlands council will see GPs inundated with patients, as they will be expected to cover work previously performed by sexual health and alcohol and drug dependency services.

The major cut backs by Walsall Council are thought to be some of the most drastic yet, by a single council. They stem from a reduction in central Government funding, which has forced the council to consult on reducing spending across many areas.

GP leaders warned the cuts to services will leave GPs 'unable to cope', with nowhere to refer to, and could put patients at risk.

It follows similar cuts by local authorities across England, including six councils that slashed their smoking cessation budgets, 20 councils that cut their contraceptive services and one which axed GP referral services for weight management and exercise.

The proposed cuts by Walsall Council include:

  • Cutting drug and alcohol treatment services by £350k over three years. This will ‘significantly diminish’ the services offered to Walsall residents, and will end the enhanced service with Walsall CCG which sees GPs screen residents to identify alcohol use.
  • A 22.5% (£500k) cut in funding for the sexual health services. This would mean all routine and non- complex patients would now be directed to their GP, rather than sexual health clinics.
  • Cease the current falls prevention service contract to save £295,000. Other options include exploring additional sources of funding from within and outside the council.

While the cuts have not been finalised, GPs have already reported receiving letters telling them not to refer patients to the services as they will soon be closed.

The council said the Government has ‘continually reduced’ funding to the council since 2010, and while it already reduced spending by £173m, it needs to save even more in 2019/20.

‘The council will need to do things differently, do different things and in some cases stop doing things that are not in line with corporate priorities or local need,’ it said on the cuts consultation website.

But Walsall LMC medical secretary and GP Dr Uzma Ahmad said this will have a ‘huge impact on general practice in Walsall’, which GPs ‘won’t be able to cope with’.

She said: ‘The cuts to sexual health will have a huge impact, especially as we have high teenage pregnancy rates. We have really worked hard in the past to address this, but now this is a step backwards.’

‘Contraception can be a very private matter for some patients and they sometimes don’t like to come to the GP for this, and that was one of the reasons why the service was developed in the first place, to ensure patients felt comfortable and would access have access to contraception.

‘Ultimately everything will come onto general practice and that is a huge piece of work that was not there before.’ Dr Ahmad said.

She explained the cuts to drug and alcohol services are 'only going to make a serious problem worse', adding that despite GP concerns being raised,  'I don’t think it will make any difference'.

According to the proposals, the cuts to the drug treatment services would mean that Walsall’s services ‘will be amongst the lowest funded amongst our neighbouring authorities’.

On the falls service, Dr Ahmad said: ‘This will have a real impact on the elderly community. We have already had letters not to refer to the service because it is going to finish soon. GPs are not going to have anywhere to refer to. This is a real shame as it was a very good service and very well-liked by the patients.

‘If you look at the consultation it is really quite insensitive. It states the serious impact on patients, but that doesn’t seem to matter.’

The report on the falls service highlighted that falls are the ‘most common cause of death from injury in the over 65 population’, and said in the last two years nearly 2,000 referrals were made to these services, most of which were frail and 60% of which lived alone.

Under associated risks, the proposal also listed an increase in the number of falls and hospital admissions, increased social isolation, and increased mortality.

Walsall council did not want to comment.

A Pulse investigation last year revealed that GPs were left to pick up the work after the public health grant for England was cut by almost 10% (£531m) from 2015/16 to 2019/20, in addition to reductions in other funding schemes that feed into public health programmes.

Budget cuts even forced a county council to nearly scrap the local infection control service for GPs, however the plan was rolled back amid risks of 'avoidable disability and death of residents’.

Readers' comments (16)

  • The three changes suggested are reducing the most obvious examples of financially sound prevention services.

    Intervening with drug and alcohol saves money for health services across the board.
    Intervening with easily accessable sexual health services reduces more serious infections, abortions and unwanted pregnancies.
    And most parts of the country feel that falls prevention services save huge multiples of the cost of implementing the service; before even considering the human and health benefits.

    It is like the council are proactively looking for areas like this, in the hope/ expectation that funding will be picked up by the other agencies that will bear the brunt of the costs of poor preventative care.

    This bickering is the number one reason why public health should have been kept out of local government hands, and within the NHS' remit. I think most health professions said as much at the time, but were ignored by central government.

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  • ObiOne is spot on: they are cutting services and making it Somebody Else’s Problem.
    The irony here is that the NHS Plan, and every STP/ICS strategy, continually emphasises that prevention is at the heart of their strategy. It’s all just empty words. And no one expects to be held accountable for the lies, or the deaths, so nobody in leadership positions cares.

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  • I am not trained to deal with STD's so will not be seeing them.

    Should I send them to A&E?

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  • Doesn’t matter whether or not you are trained. You will not be funded-end of.

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  • Not part of GMS contract any more. It is responsibility of council. So not your problem. Direct patient to Council.

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  • It would be interesting to see some objective evidence of benefit from any of these services. Falls prevention has been a complete waste locally.

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  • We are barely able to cope as it is with the conclusion that whatever the problem is then it’s the GPs responsibility regardless of whether it’s funded or not.
    Of course a reduction in contraceptive service = rise in population with fewer GPs to provide a service. Then a rise in STDs = potential increased sub fertility so less population! Except that those affected would be expected to be referred to Secondary Care for IVF or whatever other interventions are available!
    Oh dear! Is my cynicism showing! Oops!

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  • Simple answer - don't do it. I am not trained in providing treatment for alcohol dependency - I will give brief intervention but nothing more. STI I will treat but no contact tracing, and those who really want to quit smoking will have to buy NRT instead of fags. If they want champix I will prescribe the course but will not provide any other intervention. Not likely to be cost effective but we have to be realistic about what GPs can do with limited resources.

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  • At least now we'll find out if these services were actually delivering the outcomes they were commissioned to deliver!

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  • @Stelvio
    I think it is pretty hard to decide if your local scheme for falls prevention is a waste of time. It is very hard to measure 'hip fractures prevented' or 'falls hospital admission prevented'.

    I think in our are it has actually been organised and delivered well. Similarly I cannot say with certainty that it has reduced fractures/ hospital admissions/ people requiring care.

    At the same time I cannot say with certainty that treating my next 100 hypertension patients improves their heart disease and stroke risk. All I can say is the medical evidence suggests it should have helped.

    If you need objective evidence that each intervention helps, you need to become a surgeon, ideally an orthopedic surgeon.

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