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GPs buried under trusts' workload dump

GP leaders call for afternoon home visits to be passed onto ambulance services

Welsh GP leaders are calling for a change in their contract so that urgent afternoon home visits are handled by emergency healthcare services

GP leaders will vote on a motion calling for the change at the Welsh LMCs conference in Llandudno on 9 November.

Dyfed Powis LMC, which has proposed the motion, will argue that the BMA's Welsh GP Committee should negotiate an amendment to the GP contract so that urgent home visits after 2pm are passed onto urgent care or ambulance services for review.

The Welsh Ambulance Service NHS Trust and NHS 111, alongside care homes, carers and other health professionals, are increasingly asking GPs to conduct home visits, which take on average two to three hours, according to the BMA.

GPs told the BMA that home visits can be 'very disruptive' to practices, especially those managed single-handedly, given the ongoing workforce shortage in primary care and difficulties to cope with rising workloads.

GPs said the change would help address workload issues and mitigate the 'ever-growing demand' for GP services in light of a shrinking number of GPs.

Dr Eamonn Jessup, a GP in Prestatyn, North Wales said: 'This is a very interesting motion. It gives a possible partial solution to the issue of how to control an ever-growing demand for GP services from a population being served by a shrinking number of GPs.

'The majority of GPs feel there has to be a limit on the workload expected of GPs and this is a potential solution clearly worthy of debate. This is however fraught with difficulty. Would it be for all patients, how about the terminally ill patient? Will it lead to a further fragmenting of care?'

He added: 'This is, without doubt, a motion borne from the frustration of ever-increasing workload seeming to be unstoppable with an ever diminishing workforce. Somehow something has to change.'

Other motions that will be debated include:

  • A push for GPC Wales to remind service providers, in particular Welsh Ambulance Service Trust (WAST) and NHS 111, that GPs are not an emergency response provider; as the conference believes that the Welsh Government and health boards must stop the practice of GPs being expected to attend emergencies outside of practices as a replacement for a faltering ambulance service and hospital overcrowding; 
  • Assurance from the Wales general medical practice indemnity scheme that GPs will be supported when standards are breached and work dumped on GPs is handed back to secondary care;
  • A guaranty that the impacts caused by the delays in the IT procurement process is fully explained to practices and the impact on practice development during this time is fully acknowledged and reflected in the next procurement process, while the GPC ensures in future no GP practice has to choose an IT system which is in development, or even worse, a pipe dream.

Earlier this year, a Welsh GP admitted that the working hours at his surgery 'stink' while promoting a job vacancy on Twitter

A recent report by Wales Audit Office showed that the implementation of national plans to address pressure in primary care services and guaranty their sustainability has been 'patchy' and 'slow'.

Motion in full

That conference instructs GPC Wales to seek a contractual agreement that requests for urgent home visits after 2pm each working day, if not safe to leave until next day, should be passed either to a commissioned urgent care service or ambulance service for review’.

Readers' comments (24)

  • National Hopeless Service

    I do anyway. There is no blue light on my car.

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  • The problem is that everything is falling apart, emergency hospital care in A&E and lack of beds, ambulance services are not able to recruit with increasing numbers of workers resigning and retiring, not to mention the issue in general practice, which everyone knows. Passing the buck..

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  • Essentially we should only agree to work that is not urgent i.e. can wait until the next day. Anything else is so destabilising it causes us to be totally inefficient, which causes a vicious circle of loss of capacity.

    Medical problem needing immediate attention? - ED

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  • Excellent idea. We can't be in 2 places at once. This is one of biggest sources of stress.

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  • Or move to Australia. I haven’t done a home visit in 6 months, and amazingly, people get by. I lost count of how many times I was asked if I could ensure I visited by 1 as the daughter takes them out to the hairdresser in the afternoon. CCGs need to commission a stand alone home care service to which you are referred by your GP if you become unable to attend surgery. Thus visits, unless at the discretion of us all, become a thing of the past.

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  • What grinding says. It's the same in Canada. No visits, unless you want to, if you do, you get paid!

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  • Visits are are UK anachronism with overly entitled UK citizens think they have paid they're way is their right.While evidently the all you can eat free buffet paid for by the capitation fee is no fit for purpose and coming to and end.As the workforce dwindles you will be luck to see a Dr never mind have a visit.Primary care as it "used to be" days are numbered keep shuffling the chairs on the Titanic the result now will be the same whatever.As for this if you do not have capacity advise A&E and an ambulance.Pass the buck every one else passes it to us.

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  • Home visits when appropriate are in my view an important part of Primary Care. I have two so far down for today, and both totally appropriate with one for a rapidly developing ca lung and the other in a younger man who is tetraplegic due to a spinal abscess and just out of hospital. I still strive for a degree of continuity of care and handing these patients across to the ambulance service would seem unlikely to be very helpful.

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  • Peter, I agree. But urgent visits late in the day can destabilise the whole service. If it literally cannot wait until tomorrow it requires a response more urgent than primary care can be expected to deliver.

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  • Strange how I do not see people dying abroad with no home visits.
    The system needs to change and GPs should give this service up as it lends itself to abuse.

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