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.’