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The waiting game

More restrictions placed on hospitals for dumping work on GPs

The hospital standard contract for 2017/18 has been updated to include more stringent restrictions on dumping workload onto GP practices.

This includes, as revealed at last month’s Pulse Live conference, fit notes being provided by hospital medics rather than the patient’s GP.

The new contract also sets out that it is the responsibility of hospital trusts to 'respond to patient queries for matters relating to their care rather than asking the patient to contact their GP'.

It also sets out that:

  • Shared care arrangements must be explicitly agreed first by the GP, and may be funded via a LES;
  • Hospital clinic letters must be received within 10 days from this month, and within seven days as of April 2018 (down from 14 days under the 2016/17 contract);
  • Hospitals must issue medication following outpatient attendance to at least cover the patient until the GP receives the clinic letter.

The amendments follow the introduction of workload protection for GPs in last year's hospital standard contract, taking them further.

But it comes as a Pulse investigation found that not a single hospital has been sanctioned for GP workload dump despite the changes made to last year’s contract.

Alongside the announcement of the changes, the GPC has published a range of template letters and resources to help ensure hospitals adhere to the contract.

GPC chair Dr Chaand Nagpaul said the changes come as the Government 'has listened' to the demands set out in the GPC's Urgent Prescription for General Practice.

He added: 'Our range of resources for GP practices will help them make this policy commitment a reality on the ground by giving them the tools to ensure any inappropriate workload is directed back to where it belongs, as well as reporting breaches so that CCGs can take appropriate action.

'We will continue to place pressure on CCGs and secondary care managers to ensure they are meeting these new contractual responsibilities so that the hospitals and GP practices can deliver a better, more efficient service in which patients do not suffer at the hands of administrative hurdles and bureaucracy.'

Changes to the the hospital contract 2017-2019

  • Hospitals to issue Fit Notes, covering the full period until the date by which it is anticipated that the patient will have recovered.
  • Hospital Trusts to respond to patient queries for matters relating to their care rather than asking the patient to contact their GP.
  • Hospitals must not transfer management under shared care unless with prior agreement with the GP. GPs should not therefore be asked to prescribe specialist medications by virtue of a hospital letter or instruction alone. Any such shared care arrangement must be explicitly agreed first by the GP based on if s/he feels competent to do so, and which may include being resourced to do this as a locally commissioned service.
  • Hospital clinic letters to be received by the GP within 10 days from 1 April 2017, and within seven days from 1 April 2018.
  • Issuing medication following outpatient attendance at least sufficient to meet the patient’s immediate clinical needs until their GP receives the relevant clinic letter and can prescribe accordingly. 

Source: BMA

Readers' comments (11)

  • How about hospital making referral to district nurses for patients who need stitches removing. Had two of those emergencies yesterday!

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  • What happened to enforcement of the last change to the contract? Still getting many discharges due to DNAs every week. If a GP practice breached its contract every week, there would be hell to behold.

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  • What will the GPs do? Watch Star Wars.

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  • AlanAlmond

    "Moosa | Hospital Doctor19 Apr 2017 9:14pm

    What will the GPs do? Watch Star Wars."

    That sums it up perfectly doesn't it. This breath taking arrogant ignorance from a so called 'collegue' in a hospital, a sector receiving almost 95% of the entire NHS budget. This is why I'm packing it in. I'm totally fu&king sick of it. Idiot. Total tw£t. Write some discharge summaries you arse wipe, chase your own results and explain to your own patients why you can't be bother to see them. I'm done wiping your arse for you.

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  • National Hopeless Service

    I am normally more cynical than Tony Copperfield but having watched 'Confessions of a Junior Doctor' C4 my views on this have changed. Hospital medicine appears to be more sh*t than GP so I think some slack in the system is allowed otherwise we will be complicit in the sh*tfest of our junior colleagues.

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  • The medical profession in the UK is is one long S+++fest,there is nothing attractive about medicine in the UK.There are no positives in the septic tank of a country.

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  • AlanAlmond

    We've all been junior Drs - unless you didn't train in the UK. My time was just as shit as anyone's and I didn't have the benefit of the European working time directive. Being a junior Dr does not last for ever, certainly no were near the entirety of the rest of your career. I genuinely feel for my junior Dr collegues and appreciate life in hospital as a junior can suck to a degree that in some cases I'd argue has the potential to leave one with a degree of PTSD. Did you ever watch 'Drs to be'? That was filmed in the 1980s and believe me it was shit then too. However this isn't an excuse for the routine dumping of work into primary care. It wasn't then and isn't now. It is now being done 'at scale' scale, often organised at a higher administrative level with the express intention of saving cash and transferring clinical responsibility without funding out of hospital. It isn't ok and whilst I appreciate the sentiment I don't think it's helpful to excuse it on the basis of junior Dr working conditions, which is not the fundamental cause.

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  • Putting idiots and trolls like Moosa aside, I am normally fairly concerned about the hospital conditions as well as of those in General practice.
    Unresourced moving of work into primary care however is not a solution, especially when the lion's share remains in the hospital system.
    All parts of the NHS need adequate resourcing. It can be done- we are a rich country, and austerity is only a method for keeping rich people rich.

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  • Who will enforce these contractual terms? No one. It will be left to GPs to send template letters. @4/52 is spot on, if GPs breach their terms, enforcement action begins. My rent review was due more than a year ago. After multiple phone calls and emails, I had an acknowledgement from NHSE yesterday that they are looking into it. Can I enforce a penalty charge? Of course not.

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  • The problem is that the whole service is not functioning properly. Working in it is like wading through treacle. As people leave (GPs or secondary care) the remainder are put under more strain and snap!

    I qualified in 1981 and lived in during house jobs with over 120 hours a week on call - 3 in 5! It left no time for a social life and we often worked until 10pm on our "evenings off". It was exhausting but not as intense as currently. I think that we did it because there was light at the end of the tunnel but it was not right. When I qualified doctors were valued and well respected. People even thought then that the NHS would not last.

    For me the problem is that no frontline staff are valued in the NHS. Managers/politicians continuously go on about QIPP (quality, innovation, productivity and prevention) which as we all know is a euphemism for cuts and squeezing the system until "the pips squeak " If it is not easily measurable by ticking a box, or using the right code, it is not valued. Continuity and caring has been sacrificed on the alter of accessibility. In all all organisations the greatest assets are the staff that they have trained, often at great expense along with the corporate memory and skills they have. However, the current culture in society no longer seems to work like this and loyalty and integrity are ugly words. Senior managers are only judged on short term gains and the higher the better.

    As long as GP is set against GP, and Primary Care is set against Secondary Care, and even hospital department against hospital department etc ... we will never be valued. Each sector is just doing its best to survive, which means looking after number one, and saying no when possible.
    Doctors need to unite, put aside self interest and work towards a common goal. Unfortunately this is too idealistic and will never happen.

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