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The waiting game

Pulse 2019 review: GPs continue to be dumped on

Pulse’s investigation found hospitals were still treating GPs as their house officers. Allie Anderson reports

GPs just aren’t busy enough.

You’d be forgiven for thinking that’s how colleagues in secondary care view things, given their penchant for offloading work in primary care’s direction.

Because this continues to be a problem for far too many GPs, three years after provisions were written in to the hospital contract that were supposed to put a stop to the practice.

In fact, nearly half (45%) of patients who don’t show up to their first hospital appointment are immediately discharged back to their GP, according to a Pulse investigation into workload dumping.

This one-strike-and-you’re-out approach flies in the face of rules outlined in the 2016/17 NHS Standard Contract for hospitals, which bans blanket policies for automatically discharging DNAs.

Instead, discharge decisions should be made on a case-by-case basis.

Yet, it remains the default position at many of the 84 trusts who responded to Pulse’s freedom of information request. And the figures have barely changed since the contract came into force.

As a result, GPs are taking on even more work – work that should be the responsibility of hospital consultants – and in some cases, patient care is compromised.

It’s not just DNA discharges that are being foisted on frustrated GPs.

The same contract says hospitals should send patient discharge summaries to GPs within 24 hours. But data provided by 51 trusts showed there was a 12% increase between 2015 and 2018 in the number of discharge summaries being sent beyond the 24 hours specified by the contract.

That means GPs aren’t getting crucial information about their patients’ conditions quickly enough, potentially putting patients in danger.

Last year, 55-year-old Mary Chapman died after being discharged from hospital and not being appropriately followed up by her GP. The GP didn’t receive the patient’s discharge summary – nor any request to carry out a follow-up blood test – and Ms Chapman went on to develop a ‘dangerously low’ platelet count. She later died.

Cheshire’s coroner ruled that the lack of follow-up didn’t directly cause the patient’s death, but said that ‘ongoing uncertainties’ in the hospital’s ‘lengthy’ and ‘unwieldy’ discharge policy could lead to deaths in the future.

In this case, the hospital in question was a private provider – but it’s not difficult to envisage the same thing happening in the NHS. There but for the grace of God go I.

One area of workload dumping has, on the surface at least, improved slightly.

Pulse found that consultant-to-consultant referrals had risen 6% between 2015 and 2018, meaning marginally fewer patients are sent back to their GP to be referred to another specialist for a related condition.

But, given than national referrals have increased by a similar proportion, and when you factor in all the other extra work they are being burdened with, many GPs don’t feel like this is much of a win.

So much for the season of goodwill.

Readers' comments (8)

  • Vinci Ho

    It is an understatement that our secondary care colleagues are conducting business in complete disarray :
    (1) Essential information from outpatient clinics are traditionally delayed, though in some cases , patients actually received the letters way before GPs but they often had very little clue what the letters, fraught with jargons , were talking about . GPs ended up chasing for the information when the patients turned up in their booked GP appointments.
    (2) The quality of the information after discharge from acute hospital admission was variable , poor in some cases with chaotic arrangement to follow up ( or no follow-up) the patient . It is simply unsafe practice and GP had to bear the liabilities on this dumping ground .
    (3) Someone needs to count the number of GP referrals being rejected everyday as well . Children mental health services, imaging requests(radiology), orthopaedics , dermatology etc are typically the ‘no-go’ zones . In some cases , even 2 week rule cases were rejected (subjected to arguments) . Hence , this represents another virtual dumping ground .

    My concern is on the level of PCNs now. While everyone wants PCNs to ‘work’ , my cynical criticism is that might just represent widening the dumping ground instead . Integrated Care , hence, is just another name for Dumped Care .
    I can only hope that politicians, technocrats , stakeholders as well as those representing us can discern the fact from this matter precisely before pressing any button . The GP retention and recruitment crisis is on the verge of becoming irrevocable.........

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  • GPs in PCNs and in ICPs need be strong and well led to all say no...you do it...only then will trusts engage. Those that are involved must where it is suggested say no.....not enough colleagues at all levels do.

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  • There are 2 really annoying ‘dumps’ from secondary care that haven’t changed. 1) any post op complication, patient phones the hospital helpline - default ‘see your GP, same day’. Hospitals are paid for surgery aftercare but don’t seem to do it. 2) ‘Seen your patient in out-patients. I would like them to have the following blood tests. Please can you arrange and send me the results’. Why can’t they just give them a blood form?

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  • Bickering b/w primary and secondary care is exactly what the politicians and NHS beaurocrats wish for to divert the attention from where their lack of leadership has landed us all in. Divide and rule is still alive and kicking.

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  • 1 kick it back and explain to the patient why
    2 tell the lmc, ccg and anyone else, if they can be bothered to do anything
    3 remind the consultant of their duty of care as outlined by the gmc in following up tests and investigations and their patient
    4 get used to colleagues referring to you as bolshy; and don't give a gnats b+"££x about it

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  • The culture has to change. Patients should be given the responsibility to be followed-up and not the GP as it is almost impossible.

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  • But we are ideally placed!

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  • Apparently I’m ideally placed to arrange liver ultrasound for ocular melanomas every 6 months for life.

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