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A faulty production line

GP leaders to vote on new workload limit of 1,500 patients per GP

England LMC leaders are set to vote on whether to instate a new limit of 1,500 registered patients per full-time GP at a conference later this month.

The motion, set to be debated as LMC representatives meet in London on 23 November, further suggests a reduction in core hours to 8am-6pm.

It also suggests GPs’ working commitments should be measured using hours worked rather than ‘sessions’. 

The motion says the suggestions come in response to the 'clinical risks of excessive workload'.

The LMCs conference agenda will also see delegates debate the future of GP partnerships, with a motion calling on the GPC to ‘reaffirm’ its commitment to the model.

The same motion also calls for a funding increase to support measures taken as a result of the Government's ongoing review into how to promote the GP partnership model as it has significantly lost popularity.

Pulse's first-ever survey of locum GPs revealed last week than just around one in 10 locums would consider partnership in the future, with a lack of a financial incentive and concerns regarding partner workloads acting as the main barriers.

England LMC delegates will debate a range of measures that could boost the attractiveness of partnership including:

  • whether a ‘limited liability partnership’ model should be introduced in general practice; and
  • proposals that NHS England should take on liability for premises and staff redundancy costs when GP practices are forced to close.

The news comes as BMA guidance issued earlier this year said GP practices should declare ‘black alerts’ when they could no longer cope with demand, during which they would divert or cancel all routine appointments.

The guidance, which followed a BMA vote in favour of such alerts last year, suggested that 25 routine appointments a day were a 'safe' limit for individual GPs, with 35 deemed as 'unsafe'.

Last month the BMA called for the NHS’s long-term plan, which is due for publication later this month, to allow GPs to set workload limits.

A Pulse survey previously revealed that GPs in the UK have an average of 41.5 patient contacts every day - 60% more than the number considered safe by European GPs.

LMC representatives will also vote on whether the BMA should completely renegotiate the GP contract for the first time since 2004, and whether NHS England should issue multi-year contracts.

Other conference motions focus on:

Motions in full

AGENDA COMMITTEE TO BE PROPOSED BY SHROPSHIRE: That conference, mindful of the clinical risks of excessive workload, believes that:

(i) an assessment of a GP’s commitment should be based on total hours worked rather than sessions

(ii) the core contracted hours should be reduced to 08.00 hours – 18.00 hours

(iii) a limit of 1500 patients per WTE GP should be set as standard.

SURREY: That conference:

(i) reaffirms its support for the GP partnership model of delivery of primary medical services

(ii) urges that any acceptable outcome of the current GP Partnership Review includes a direct financial uplift in GMS Global Sum and/or PMS Global Sum Equivalent.

AGENDA COMMITTEE TO BE PROPOSED BY CAMBRIDGESHIRE: That conference calls on GPC England to reduce the inherent risks in the current partnership model that are alienating GPs and pushing experienced GPs into early retirement by negotiating with the government to:

(i) introduce a form of Limited Liability into the partnership model for contract holders

(ii) recognise the financial burden of taking on a partnership by seeking full reimbursement of necessary costs incurred in providing NHS premises

(iii) require NHS England to cover staff redundancy costs in the case of list dispersal

(iv) ensure NHS England is obligated to take over the lease of a collapsed practice and act as a tenant of last resort

(v) introduce a statutory cap to the liability which can befall a contractor who finds themselves in the position of being 'last partner standing'.

Source: BMA

Readers' comments (23)

  • Really?
    So this would in effect cap your earning potential too then? Some practices can cope with 2k per GP as they employ the right staff to help them.
    Indiscriminately applying this would mean a hit on income and therefore make the job look less attractive yet again. Properly funded general practice that’s well supported and rumunerated is all that we ask. Support the ‘bedrock’ of the NHS as Hancock puts it. This is cutting your nose off to spite your face in my opinion.

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  • Peter Swinyard

    Could those going to the LMC Conference please consider sending motion 303 as a chosen motion? Conference is far too dull - this may help! Has to be in by end of weekend so please have a look today!

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  • Limit income and er no GPs to recruit, fabulous idea, enough problems with government trying to finish us off, wasn’t expecting BMA to lend them a hand

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  • AlanAlmond

    James Weems | GP Partner/Principal06 Nov 2018 3:02pm

    As more and more of the work force shun partnerships to Locum or work as salaried employees there is a danger that the views of partners become more ‘niche’ and less representative of profession as a whole. Yes you can earn more as a partner by a having greater number of patients on your list, but how do you achieve this? By employing ‘the right staff’ you say. Who are these ‘right staff’ I wonder? A raft of salaried grunts slogging out all the clinical sessions whilst you concentrate on ‘managerial issues’ and CCG meetings? or pharmacists/ANPs and noctors? Ok for you I guess but the folk you employ see none of the financial benefits. Wonder why people leave salaried jobs to become locums? Probably in no small part to these kind of partner based financial motivations. I dont think this is good for the profession as a whole irrespective of your personal earning potential. Sorry.

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  • AlanAlmond

    ...I agree with the LMC motions. The GP workforce crisis is about work load, not how much the highest earners can potentially rake in. We can’t all be senior partner at the Hurley group...the way things are going most of us aren’t even going to be partners and are actually destined to be salaried, the number of patients on the practice list will make no difference to our pay packet, but all the difference to the size of the morning and evening surgery, noctor or not.

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  • So many rules.....all done by people who do not see patients so they are immune from the tosh coming out.

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  • Easy peasey pay per consult then we can do as little or as much as we want.Lets call it a copayment system.Lets no go down a communist cuban route.

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  • Limiting individual GP list size to 1500 won’t happen in my opinion. Where would all the extra GPs suddenly appear from? I very much doubt that adequate money would be found for this, so salaries will drop. I’m sure GP surgeries dealing with a large student population wouldn’t be too pleased. I do think though that there does need to be an on the day ‘black alert’ though.

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  • NOoooooo, we have a balance of paramedics, minor illness nurses, practice nurses and HCAs with the most appropriate HCPs seeing the patients. Combine that with efficient working, post management / workflow, prescription reconciliation clerks and more then you can easily run with a list size double that. Wrong knee jerk reaction. Sort out the inefficiencies in the system first.

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  • Took Early Retirement

    Hot air

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  • In the golden olden days there was a guy I think called Marsh who suggested that GPs could quite easily look after 4000 patients provided that we were properly supported. The fact that this didn't seems totally outrageous reflects how much the job has increased and how much less support we now have.

    And by the way the early 80s really were golden in general practice.

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  • where would all the other patiients go to?

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  • Can we first define what a full time GP is? 9 sessions, 8 sessions, 7 sessions? 37.5 hours?If we don't get this starting point nailed then the rest is doomed.

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  • how about just let each GP decide how many patients they can handle or want. Many GPs now want to close their lists as too busy and aren't allowed. forcing those that are coping to stop accepting patients isn't good for them or patients. Some demographics are more work so you wouldn't want as many patients elderly versus lots of students. Stop micromanaging and removing autonomy. Its pretty easy really.

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  • Bob Hodges

    Ockham's Razor does not apply here. If your apparent 'simplest answer' is this nonsense, then you've asked the WRONG QUESTION.

    Workload, not patient load, is the problem. 31 year olds with nothing more than self-limiting illness or low level psychological acopia should not be the same room as a GP 6 times per year.

    This is wrong on so many levels and is an irritating waste of energy. It also suggests that we should return to the old ways and have personal lists and to the stethoscope waving ritual at 10 minute intervals for EVER.

    The future is 'Primary Care consultant' model with GPs doing the difficult stuff in appropriately long time slots.

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  • Vinci Ho

    I understand why this kind of motion got slagged off easily because it appeared to be looking for a single , discrete ‘antidote’ to our problem of workload. Indeed , it is , to a large extent , about the ‘type and quality’ of the patients on my list . 1500 university students are clearly different from same number of over 65 years old on a GP list ( which is why we are loathing what Babylon and GP at hand had done so far).
    But , always a but , if this measure was only one of many other ways to reduce our workload alongside with appropriate resources increase( time , manpower , expertise and of course, money at the same time), it is still worth debating.

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  • This is nonsense as it will cap our earnings. What is needed is an acivity based contract and get rid of all QOF, GMS, PMS Car-Hill etc. This is easy to administer and there will be no arguments that Car-Hill favors the wealthy elderly population. This will promote access as with increased access comes increased revenue.

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  • Makes sense if you pay enough to employ a 2nd GP and reimburse rent to ethnic GPs the same way you do to white british colleagues. Unless you remove the apartheid mentality from CCGs and NHSE who give lucrative contracts to some (without tenders) and slave drive others, there is no need to vote for successive changes. Voting is one thing - getting things implemented completely a different song.
    The first thing that needs to be done is cleansing the system of corrupt nogooders in NHSE,CCGs and even LMCs !

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  • doctordog.

    ‘Clinical risks of excessive workload ‘
    Is that risk to the doctor or the patient ( or both)?

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  • I agree about the activity cap but the thought of the role of the ‘Prinary Care Consultant’ mentioned at 09:43, depresses me. It suggests that GPs will only be dealing with the complex, probably elderly patient with heart sink patients as well. I feel I already see a lot of these patients but the odd sore throat interspersed allows light relief as well as a catch up on time.

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