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GPs told to 'maximise capacity' and call in off duty staff to tackle urgent care pressures

Exclusive GPs have been told to maximise capacity by cancelling ‘discretionary services’ and recall off-duty staff in a bid to relieve pressure on struggling urgent care services, Pulse has learnt.

The NHS England Bristol, North Somerset, Somerset and South Gloucestershire (BNSSSG) area team also asked GPs to work from home to ‘process incoming letters’ wrote to practices after a spike in the number of frail elderly patients presenting in secondary care with acute respiratory infections.

The area team also told GPs that ‘any disappointments that [secondary care clinicians] experienced in primary care responsiveness demanded highlighting’.

This comes as urgent care services across the UK have been struggling to cope with winter pressures, with GPs being widely blamed for a lack of access, while Pulse has reported that GPs in Essex were paid to work on New Year’s Day to help urgent care services.

The original letter from the BNSSSG area team, dated 7 January, stated GPs should: ‘Take all actions to maximise capacity in the surgery, calling on any “off-duty” staff as appropriate.’

It added that practices should ‘seek to cancel discretionary activities in order to free up more urgent care slots if there is excess demand, in line with acute and community trusts’.

The area team told Pulse that the discretionary activities that the letter referred to included ‘staff training and planned care that could be recoverable later on - an example used in some practices was that they have safely scaled back planned contraceptive services.’

After a backlash, a subsequent email was sent out on 14 January, with a list of actions that could be, or were already being, undertaken by practices to increase their capacity.

One of the suggestions was to enable ‘some tasks to be undertaken by “home-workers” such as part-time GPs processing incoming letters, results etc’.

In the second email, the area team’s director of commissioning, Linda Prosser, said the stability of the urgent care service over Christmas had been down to the extra hours GPs had put in.

But, she added: ‘You will appreciate from your peers working in other parts of the system, including acute trusts that their pressures have been intense too, such that any disappointments that they experienced in primary care responsiveness demanded highlighting.’

Ms Prosser also acknowledged that ‘we can never really know’ if patients reporting they attended A&E because they were unable to get a GP appointment actually tried.

The area team told Pulse it recognised GPs were already taking on additional appointments and working extra hours but taxpayers and patients reasonably expect practices to take a ‘proactive role’ in enabling the system to cope with winter pressure.

But Avon LMC chair Dr Mark Corcoran told Pulse that the initial letter was ‘crass’ and ‘created a backlash, created anger and angst amongst local GPs’

He said: ‘The original letter, says “take actions to maximise capacity in the surgery calling in any “off-duty staff” as appropriate, which I think was a little bit crass.

‘Obviously it’s not a good time to have staff away, and I think most GPs are aware of that, and they’re not going to reduce staff at times when there’s going to be an obvious need.’

However, he said the second email ‘was much more understanding, and did have some good points that I think we can work with’.

Dr Corcoran said the call for a system wide review of inappropriate demand over Christmas and New Year was particularly important, and should be looked at nationally.

But he added: ‘I don’t quite know why they think we’re all going off on study leave all the time.

‘We don’t have spare capacity, we don’t go off on study leave, if we are doing CPD we’re often doing it online or we’re doing it in the evening. We don’t take days off on a regular basis to go off and have a jolly, so it’s just not something that we do.’

Readers' comments (36)

  • just been sent this from a friend:

    URGENT MESSAGE: RESPONSE REQUIRED BY 2PM TODAY.

    Please see below and attached from >>> regarding the planned industrial action by Health Unions on the 29th January 2015.

    London Ambulance Service are requesting the support of one GP from each CCG across London, to provide emergency cover during during the strikes.

    The CCG needs to report back to NHS England by 14.00 today that they have identified a individual to perform this role.

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  • Give me funding for another f/t gp and i will improve access. Unfortunately, the plea for equal funding has fallen on deaf ears and the explanation is 'it's historical' - does not justify why a Practice with 4150 patients receives 21k global sum per month while another with 3500 gets 30k. The differnece in global sum payments discriminate against patients some of whom are lesser citizens of this country and NHSE allocates as low as - £54 for their care per year ( as calcullated for my Surgery by my Accountants for year ending 2014.
    Does NHS Fraud look into allocation and formula manipulations at the PCA level. Probably not, The govt has created untouchable quangos over which they don't have influence.
    If you can't give adequate funding, don't expect access to improve.
    DMC in Gillingham is given 2.5 mln per year for a walk in Centre. I bet GPs could provide better service for half that sum 7/7 and 8/8

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  • Vinci Ho

    Is it fair to say this is to 'get blood out of a stone'?
    Why can't people be honest and stand up pointing the finger to these bureaucrats and executives, 'cough up more money , then have more access in all aspects e.g. GP, social care and of course , A/E'

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  • What? What world are they in? Come and experience general practice first hand before telling us what we should be doing. Any advice should be given from a position of knowledge. We are working to capacity all year round - this is the problem. There is no longer any slack in the system.

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  • tell, tell, tell.......if these people actually entered into discussion, there might be a bit more willingness to help, providing there was a longterm strategy to address the issues.
    Expecting doctors in all fields to take on more work increases the risk of things going wrong.
    Deal with the patient demand (which is mostly inappropriate) to free up doctor resources, and provide adequate funds, and the system will work!

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  • general practice is imploding, we haven't got the resources for this, many gp's are at the brink of burning out and if they do many won't be able to be replaced with anything other than locums putting more pressure on remaining gps. the government need to attract more gps into permanent positions or face a worsening crisis. wake up and smell the coffee

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  • I will keep my language polite - but it does not reflect what is in my heart. The politicians are worked up about ED pressures because they choose to measure them. The whole system, including Primary Care, District Nursing and Social Care is at breaking point. Try measuring GP workload and getting aerated. Do they even know what we do? I doubt it. Do they know I work 11-12 hour days and am continually frustrated with poor discharge summaries, patients admitted and sent out with no problems addressed - so they are back in next week. I despair - we need a non-political NHS management (in my dreams). Actually Managers are not stupid - so clearly the agenda is to break Primary Care and let in their private health buddies.

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  • Discretionary activities may of course be the yearly grind of catching up on QOF targets in order to be paid to run the service. Or maybe identifying the demented, of which there is a great supply of examples in Westminster and NHS England.
    What parallel universe do these people live in. It is their ilk who have created the problem by systematically failing to invest in primary care ( as advised by highly paid, special consultants, who are of course unaccountable).

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  • Thank goodness I've resigned

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  • Anyone elderly ie aged 65 and confused is pretty much an automatic hospital admission due risk of death, perhaps more hoital beds and nursing care be provided which would alleviate these pressures.

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