Over £4m of NHS funding is wasted on ‘interface’ issues between primary and secondary care such as workload dump, according to GP leaders in one area.
In a report published today, Humberside LMC has estimated the cost to the NHS associated with interface difficulties, including poor communication from secondary providers, inappropriate transfer of work, and rejected referrals.
Based on a survey conducted in September last year, LMC leaders predicted that GPs have to deal with 6,600 interface problems across the Humber region each month – this amounts to over 1,800 clinical appointments per week, or 97,000 in a year.
The LMC calculated that this time burden equates to £4,076,800 of NHS funding a year, and if replicated across the country, the total waste would be £223m.
GP leaders called on the integrated care system (ICS) to tackle interface issues, describing it as a ‘quick win’ which would free up clinical capacity across the system at little or no cost.
The report pointed out that while acute providers were the single largest source of interface issues, other providers including mental health and community accounted for nearly two thirds of the monthly burden on general practice when combined.
‘Undoubtedly, there is much to gain from improving the interface between general practice and acute trusts. However, we recommend system resources do not disproportionately focus on improving the interface between general practice and acute trusts but ensure that the interface with other providers is appropriately addressed,’ the report said.
Humberside LMC’s survey on the primary/secondary care interface received 89 responses from general practice staff across the entire region, over half of which were GPs.
The report said the geographical coverage of responses means the survey results representative of general practice across Humberside.
GPs were asked how frequently they deal with workload dump, from which providers, what types of difficulties they face, and how long it takes to resolve them.
More than half of respondents (56%) spent more than 30 minutes resolving issues each week.
The main issues identified:
- Poor communication, for example providers failing to inform patients of their test results;
- Inappropriate transfer of work, for example difficulties relating to clinical investigations or GPs being asked to initiate onward referrals;
- Referrals, for example rejected referrals or inappropriate advice and guidance (A&G).
Many survey respondents reported issues which revealed ‘widespread, regular contract breaches by providers’, with the LMC calling on ICBs to ensure providers keep to their contractual obligations.
‘Interface difficulties have a pernicious, profound, and widespread impact on healthcare provision. They avoidably drain clinical capacity from a healthcare system that is already financially strained,’ LMC leaders said.
The report also highlighted that its calculations are based only on the time GPs spend resolving issues, because data is not available for the total number of non-GP roles across the region. As such, the true cost and impact on general practice will likely be much higher.
Humberside LMC chief executive and medical director Dr Zoe Norris said these problems ‘place a huge burden on general practice’ and lead to ‘wasted time’ for the workforce.
She said: ‘We’re calling for a renewed focus at system-wide level to tackle the interface burden, with action to eliminate the common interface problems which the report highlights.
‘Despite the problems highlighted we hope that, through shining a light on these issues, all of us working in primary care and the wider NHS will be able to reduce the unnecessary burden of unresourced work arising from interface issues.
‘While our report looks at the situation in the Humberside region, LMCs across England are seeing similar challenges. If the cost we see locally is mirrored nationwide, this represents a total of over £223m of NHS resources that could be better spent in general practice.’
Humber and North Yorkshire ICB told Pulse that it welcomed the LMC’s report and looked forward to continuing to ‘work with them to address the identified issues’.
A spokesperson said: ‘The ICB is committed to delivering the primary care recovery plan objectives, which include interface improvements.
‘Work is ongoing with acute providers and primary care colleagues to address the interface priorities, which has already seen some improvements made. There is a commitment from all parties to keep up the momentum and improve further.’
NHS England’s primary care recovery plan promised to reduce workload dump on GPs by improving the primary/secondary care interface, including a pledge to stop patients being sent back to GPs where they need onward referral from one consultant to another.
However, ICBs have reported issues with progressing this work with some saying secondary care has not prioritised improving the interface with general practice.
Cheshire and Merseyside ICB said in its autumn update on the primary/secondary care interface: ‘This workstream requires collaboration across the whole system. There is concern that secondary care may not recognise the need for this work, seeing it as an issue facing Primary Care, rather than as a true system issue affecting patient pathways.’
Norfolk and Waveney ICB said capacity within secondary care to address interface issues is ‘limited due to focus on other national priorities’ such as elective recovery, while health leaders at Surrey Heartlands simply said ‘industrial action and winter planning has to take priority’.
Last year, a think tank report warned that at least 15 million GP appointments are wasted each year due to issues arising from the poor interface between GPs and hospitals.
And GPs in London were encouraged to submit ‘quality alerts’ to ICBs when they experience workload dump from hospital trusts.
READERS' COMMENTS [10]
Please note, only GPs are permitted to add comments to articles
This doesn’t surprise me.
It isn’t a ‘quick win’ however. Changing the cultural beliefs from secondary care doctors, nurses, administrators, commissioners, mental health teams, coroners, NICE, social workers etc that GPs will ‘kindly’ do tasks that they could well have done (quicker and with less handover risk) themselves involves repeated and persistent feedback to 100,000s of workers. They ability to unilaterally pass on a risk or task and make themselves uncontactable or unidentifiable for response means the default sits with primary care until proven otherwise, and this can take years for some issues. This is only worsening with the view that accepting a referral is some kind of personal favour once the GP has had a go at every suggestion sent back to them rather than a default position unless obviously the wrong service.
In some ways it is better to be oblivious and suck it up than to get excised about the absurdity, increased risk and time wasting that our system supports. It’s a painful long road to challenge every single instance, and one that can’t be delegated given the individual time sensitive clinical risks that sit with the GP who last saw the inappropriate work dump.
Almost all workload dumps are in direct breach of the NHS standard contract for NHS Trusts – yet the commissioners never impose any sanction or meaningfully seek to enforce those contractual obligations. The endemic dumping behaviour never changes, and the inappropriate transfer of unfunded work just gets worse and worse.
If it were ever the other way round, they would come down on GP like a ton of bricks
GPs shouldn’t have to challenge every individual case. We have reported endless examples. The commissioners should fulfil their role and get a grip on this.
The two comments above are so spot on. Unfortunately, no one – other than those of us not already burnt out, gives a sh1t.
2′ care remains (for now) the sacred fatted cow
The emeritus scheme announced today for retired consultants and other pay grades to tackle waits is a perfect example-BMA has made more headway with T+Cs and pay for 2′ care colleagues but GPC has failed to secure (so far)much that’s meaningful for GPs
HMG hope that AI will shake things up across both sectors and will tough it out
Hospitals dumping their work on us is a form of bullying.
The only response to a bully is to stand up to them.
In this case it involves the slow tedious job of sending each and every individual dump back to the dumper with a note explaining why they must do their own work.
It doesn’t cost NHSE/the govt anything because they don’t fund it. That’s the whole point. It is unfunded work GP surgeries do for free. It does take workload off secondary care so effectively it saves NHSE/the govt money by making GPs do secondary care/everyone else’s work; FOR FREE. That is the essential point this article, any everyone, is missing. Primary care needs to obtain appropriate funding for this work, the LMC has bothered to cost it up. Now do something with it. Demand and obtain the appropriate funding you’ve costed or refuse to do the work so NHSE/the govt/the ICs are incentivised to allocate that funding. Seems fairly obvious to me.
Yep. It’s totally unfunded work that we do for free.
But, worse still, the taxpayer has already paid for this work to be done as it is included in the tariff prices that the hospital and other providers get paid for each and every interaction.
Doing their own investigations; chasing those results themselves; communicating the results to patients properly; recalling patients appropriately (even if it’s in a few years); doing their own referrals as they see fit; issuing urgently necessary or specialist medications; giving their patient a fit note when it’s needed – it all in there, bought and paid for. And it remains their contractual responsibility because it makes total sense clinically – I would rather they just bloody well got on with it.
The commissioner should try stepping in when they don’t. “Interface meetings”, good intentions about making changes, hand-wringing, and feigned concern over many years has clearly achieved nothing.
Finola O’Neill : spot on. The NHS and ICBs are getting millions of pounds work done, but we GPs are paying for it out of our own budgets (and in the case of partners our own pockets)
This is a really good piece of work, and I think it is really helpful to try to start to quantify the scale of the problem.
I suspect it is actually the tip of a very large iceberg, though. I have never known such a large and unrelenting attempt to shift work from hospitals (and other providers) into general practice, and to try to compel us to take it on despite it not being in our contract and not funded.
It’s not just the hospitals, though, and it isn’t unintentional – it is the ICBs, a range of other providers (including private ones), and it is clearly a deliberate (but unvoiced) policy. Even the GMC and NICE have tried to do it.
The headline is incorrect though – as Finola has suggested, it isn’t ‘Workload dump on GPs costs the NHS £4m in just one region’, because it isn’t costing the NHS a penny. The NHS is in fact saving £4m by coercing GPs to undertake extra work that they are not contracted nor funded to deliver. The headline should be ‘Workload dump on GPs means that GP partners are subsidising the NHS and hospitals to the tune of £4m in just one region’.
GPs can’t bring themselves to say no and hence it continues. The only way it will stop is if there is tariff chargeable to the trust for each and every item of work transfer, at which point it will end overnight.