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Four in 10 GPs asked to provide public health services without payment

Exclusive  Four in 10 GPs have been asked to provide public health services without being paid in the past year, Pulse can reveal.

In a Pulse survey of over 400 GPs, 40% said they had received requests for unpaid public health work, including administering vaccines and prescribing antivirals.

GPs warned they can only ‘go above and beyond’ for so long before they burn out, and said they cannot be expected to make up for the ‘deficiencies’ of poorly commissioned public health services.

The survey of 424 GP partners found 171 (40%) had received such a request in the past 12 months, 172 (41%) had not, and 81 (19%) did not know.

When asked about examples, GPs listed everything from hepatitis B vaccinations for police officers to tamiflu vaccinations in nursing homes, and contact tracing for measles.

In one case, GPs and practice nurses were left no choice but to cycle to vulnerable, housebound patients’ homes to provide flu jabs, as the community nurses were so under-resourced.

Another GP said they had patients redirected from the local sexual health clinic to the practice, because the clinic was short of staff.

Last year, practices in Worcestershire were asked to trace patients who had come into contact with measles. Local GP leaders said one practice was even put under ‘undue pressure’ to provide information on all patients who were in the waiting room at the same time as a patient who was later diagnosed with measles.

St Helens GP partner Dr Eithne McRae said: ‘I frequently get asked to give adult hepatitis B for at-risk workers who should be getting this through occupational health service – especially police officers.

‘The officers report being “sent to their GP” for this service. I can argue until I am blue in the face and end up giving it in the end as the patients are at risk and are not being protected through their occupational health service.’

Lincolnshire LMC director Dr Kieran Sharrock said this is a ‘significant problem’ in his area.

He said: ‘Practices have been requested to perform multiple public health tasks, and some have unwittingly provided the service without realising that it is not their role.

‘Clearly, we want to provide these services for patients, so that they get timely intervention close to home, but we cannot do this without funding as GP and staff time is used to provide the services.’

Dr Sharrock said the local public health department and CCGs are now working with the practices to allow them to get ‘appropriate funding’, and while this is not yet finalised, it is ‘progress’.

Last year, GPs in Lincolnshire were told to refuse requests to carry out public health services for which they are not being paid, to enable local representatives to add pressure and negotiate payments.

Londonwide LMCs chief executive Dr Michelle Drage said: ‘Cuts to public health funding, sexual health services, smoking cessation and community nursing have seen general practice asked to take up the strain with no extra resources.

‘One practice I know of even had its doctors and nurses cycling to vulnerable, housebound patients’ homes to provide flu jabs, because community nurses were so overstretched. There is only so long GPs and nurses can go above and beyond like this before they burn out.’

Family Doctor Association national chairman Dr Peter Swinyard said: ‘Quite simply, if they have not commissioned the service, it is not available – we are generally not happy in general practice to be the handmaiden of a poorly commissioned service and to make up for its deficiencies.

‘If they want GPs to do these things, they should agree a Local Enhanced Service with the local LMC.’

Pulse investigation last year revealed that GPs were left to pick up the work after the public health grant for England was cut by almost 10% (£531m) from 2015/16 to 2019/20, in addition to reductions in other funding schemes that feed into public health programmes.

Budget cuts even forced a county council to nearly scrap the local infection control service for GPs, however the plan was rolled back amid risks of ‘avoidable disability and death of residents’.



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