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Not a single hospital sanctioned for GP workload ‘dump’, finds Pulse investigation



Exclusive Not a single CCG has enforced a contractual requirement on trusts to stop dumping work on GPs, a Pulse investigation has revealed.

As part of the GP Forward View released last year, NHS England changed trusts’ standard contract to prohibit them from sending patients back to GPs unnecessarily.

But Pulse has revealed that – despite GPs making 3,600 formal complaints to CCGs – not a single one has resulted in any kind of sanction for trusts.

Instead, the GPC said that hospitals are dumping even more workload on GPs since NHS England implemented the new measures last April.

The new measures introduced a number of changes to the NHS standard contract for trusts and other providers, including:

  • Cracking down on patients being bounced back to GPs after they failed to attend a secondary care appointment;
  • Encouraging consultant-to-consultant referrals for conditions related to the original referral;
  • Ensuring that trusts provide patients with the right information or adequate medication.

But a Pulse FOI answered in full by 93 CCGs reveals that, extrapolated across the whole of England, there have been around 3,600 complaints made by GPs about hospitals failing to carry out these contractual requirements.

The same FOI revealed that not a single CCG had taken any sanction against hospitals for failing to carry out their contractual requirements.

Dr Robert Morley, GPC contracts and regulation lead and executive secretary of Birmingham LMC, said: ‘CCGs appear to have been totally impotent in being able to hold secondary care providers to account for this.’

He added that workload dump from secondary care has always been a problem, but it ‘appears to be getting worse’.

NHS Bristol CCG told Pulse it had received 156 complaints from GPs and has taken no form of remedial action.

But Avon LMC chairman Dr Mark Corcoran said this was a ‘gross underestimation’ of the problem.

The LMC carried out its own survey of the issue over a one-month period in November 2015 before trusts’ contractual changes, which found practices were reporting on average 42 examples of inappropriate workload being dumped on GPs by secondary care each month.

The GPC has devised template letters for GPs to use when encountering examples of workload dump.

Dr Corcoran said their letters are not yet routinely used by practices.

He added: ‘GPs don’t report all these to CCGs. We have tried to send out template letters to GPs but unfortunately they don’t seem to know about them. If they did, the numbers would go up hugely.’

An NHS England spokesperson said: ‘We understand the pressures on GPs and this is why we have introduced new contractual measures to help reduce bureaucracy and red tape.

‘While CCGs are responsible for ensuring these requirements are met, breach notices and penalties are a last resort and so it is likely that action is being taken to resolve complaints before this stage is reached.’

The rules banning hospitals from GP workload ‘dump’

The rules, first outlined with the General Practice Forward View last year, were added to the 2016/17 NHS Standard Contract for hospitals.

The GPC had asked for NHS England to review secondary care workload dump as part of its Urgent Prescription for General Practice.

The rules set a time limit for hospitals to electronically send discharge summaries to GPs, enable consultant-to-consultant referrals, requires hospitals to supply medication on discharge and require hospitals to notify patients of results of clinical investigations.

NHS England has said the rules would ‘enable GPs the ability to see patients more quickly, thereby reducing the likelihood of A&E attendances and emergency admissions’.