Patient allocation: a real problem for my practice
f morale is to be maintained in general practice, if patients are to receive satisfactory treatment, and if there is to be any hope whatsoever of recruiting more GPs, the allocations problem must be given the very highest priority in the new contract.
Certainly my practice has been suffering a great deal over the issue of forced allocations. It's a real problem in this part of the country.
We were already under pressure at the beginning of last year. I wrote to our practice health authority informing them we had reluctantly decided to close our list to new patients apart from new babies born to existing patients, previously registered patients, and temporary residents.
We had found ourselves coping with an increasing number of 'urgent' problems which patients felt could not wait until the following day, in addition to the already heavily booked normal surgeries. The NSF guidelines were also impacting on the workload, and all members of the team were feeling this. We felt that taking on new patients was increasing the workload to a point where safety would be compromised.
Our action was also in anticipation of problems arising because a neighbouring two-doctor practice had been unable to replace one of the partners who had retired in July 2001 the old recruitment issue again! As a result, the remaining partner had decided to resign from the practice in February 2002. The health authority considered dissolving the practice and allocating the patients.
In June 2002 the health authority reached agreement with another singlehanded practice in the town to take over the patients of the demised practice from September, on the understanding that additional doctors would be recruited.
For various reasons some patients were unhappy with this and they tried to register with other practices in the area. During July the other three practices wrote to the health authority saying they were unable to take on more patients and would be removing any allocated patients after the statutory minimum seven days.
Our practice policy from the date of closing our list in January 2002 was to remove patients on the day they were allocated to us, although we ensured that any immediate medical needs were met.
At the end of July our own position was made worse when we had one partner away on paternity leave, another on holiday, and I was unable to see patients because of a hand operation.
This was when our problems with allocations really kicked in. Over the next few months we were receiving about 20 allocations per week all of which were removed.
It was obvious that there was a nucleus of about 60 patients who were simply being passed from one practice to another, in addition to the unfortunate new families who were moving into the town and were trying to find a GP.
In October we were informed that we had to keep any further allocations, and that we were being summoned to appear in front of our PCT under the terms of an 'allocations appeal process'!
We were soon advised by our LMC chief executive Dr Judy Gilley that no such process existed, and that we were within our rights to continue removing allocated patients if we felt we could not take on more work. By the end of November all the local practices had reached an agreement whereby list sizes would be capped at an agreed level after verifying list sizes with the health authority, and a 'waiting list' would be introduced by each practice so that new and allocated patients would be taken on permanently by each practice as soon as they had a vacancy.
The PCT has since made plans to employ a part-time locum at one of the practices so that new patients and allocations could be directed towards that practice.
We will monitor how this scheme works but continue to remove allocated patients and only accept new ones when our list falls below our planned maximum.
The new GP contract promises to solve the 'enforced allocation problem', but it is difficult to imagine how it will do this when the basis of the problem is the increasing GP recruitment crisis.
How will the new contract solve the allocation problem when the cause is the GP recruitment crisis?~