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Independents' Day

Is the workload dump from secondary care subsiding?

Editor’s blog

It has been three years since the GP Forward View imposed contractual obligations on trusts to stop dumping work on GP practices.

However, I am not sure this has made any difference. It seems to me that GPs are still being asked to re-refer patients who miss a secondary care appointment, and are still having to chase discharge letters.

I ask myself what NHS England would do if GP practices basically ignored their contractual requirements like this

So it is maybe no surprise that the chair of the RCGP has had to come up with a novel way of countering this. She is asking patients to take pictures of the consultant’s notes.

Now, this seems pretty clever to me. But we do have to ask ourselves why GPs are having to resort to this. Trusts are under huge amounts of pressure too, but in order for the whole health service to function better, they should be looking for ways to deal with missed appointments, using consultant-to-consultant referrals without involving the GP and actually getting discharge letters to GPs in time.

I ask myself what NHS England would do if GP practices basically ignored their contractual requirements like this. I think we know the answer.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at

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Readers' comments (10)

  • Cobblers

    Lady Double-Barrelled is suggesting taking a photo of the paper, or presumably computer notes, to take to the GP and Jaimie you're impressed? Dear me. It's a "Make Do and Mend" philosophy no more. It should not be necessary.

    40 years ago the system got the letter to the GP in 3-4 days.

    Here we are with the admindroids having cut support services to the bone whilst themselves proliferating, nay metastasising. And we can't get letters to the GP in almost any time?

    I have had a couple of recent experiences as a patient in OPD. I watched as the doctor transferred my verbal history to a digital form. They then entered the examination, bloods, and treatment, again in the same manner.

    So we have a digital record.

    That record can be accessible by any number of means or even sent SMS, email, or snail mail.

    It is not difficult. It requires a bit of thought. Perhaps the OPD session should not be paid by the CCG if the communication is not immediate? That should be an incentive.

    Or should, when I next go to the OPD, take my Polaroid?

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  • God help any of the GP's whose patients give them a Polaroid of the notes I take in my dermatology clinics.

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  • If a patient takes a picture of notes it doesn't reduce workload, it just means another patient appointment.
    As was pointed out above I remember summarising notes in 1967 when discharge letters were typed and sent on the day of discharge!! An impossible fantasy in 2019

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  • Dumping has increased exponentially

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  • Jaimie, you are correct that workload "dump" from secondary care continues. Appointments for sick notes that apparently secondary care said had to be done by the GP or could only do for 2 weeks, requests from super-specialists to refer to another super-specialist within the same specialty, and weeks to months of waits for clinic letters continue. And on top of this are all the appointments along the lines of "my hospital appointment isn't for 5 months and I can't possibly wait till then" - the irony of the effect of this on access to GP appointments doesn't seem immediately apparent to many. This latter type of appointment is a daily occurrence (at least).

    Many of these issues are down to resourcing. Some are down to ignorance of the correct processes. Overall, the workload in primary care due to work not being done in secondary care but that should be done there appears to be increasing.

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  • DrRubbishBin

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  • the hospital should give the patient a med3 to cover "expected time off work", not just to cover their time in hospital. all hospitals have been told this, several times. explain to the patient they have been misinformed by the hospital/consultant/ward/sho/hospital porter/whoever looked after them. send them back to the ward, with a snotogram from you reminding those responsible of their responsibility. explain, carefully, to the patient that you CANNOT give them a med3, because the hospital haven't told YOU the details of what THEY have done. when those at the other end phone the surgery to have it out with you, explain to receptionist (beforehand) that you cannot talk to them - you are too busy. i had one stroppy hospital doctor who simply wouldn't cooperate - until i asked for his gmc number and threatened him with the gmc, when he rolled over. all rather unpleasant and unnecessary - rather like a lot of the donkey work that is dumped on us !

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  • "The hospital told me to come here to get my results". I hear this about 3 times a day. Not just dumping but medicolegally wrong

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  • In a system atr breaking point, the time is more for a systematic senior review of NHS roles in relation to resource priorities. 'All things to all people' (and for free): When has that ever ended well? Political governance is currently in moral hazard (power without responsibility). And when did that ever end well either!

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