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Hospitals to ‘eliminate unnecessary’ workload dump on GP practices

unnecessary bureaucracy

Secondary care providers must be ‘held to account’ to eliminate unnecessary workload dumping on practices, such as blood tests and prescribing, NHS England has said.

However, there are still no plans to further protect QOF income, after income protection ended in April.

NHS England yesterday set out measures to tackle GP bureaucracy as part of its £250m winter ‘support’ package for general practice.

The plan – which aims to improve access to GP services and ‘support’ practices – said that as part of their 2021/22 contracts, secondary care providers must ‘assess and address certain processes that generate avoidable administrative burdens for GPs’.

It added: ‘NHS England has emphasised that local system plans should hold providers to account for eliminating any unnecessary redirection of activity to general practice from other providers where this could reasonably be arranged directly by that provider, for example phlebotomy, organising investigations and, in particular, prescribing of medications.’

The transfer of patient data from secondary care to GP practices will also be improved by ‘removing the need to send email attachments or paper letters requiring manual processing’ later this year, it said.

NHS England added that it plans to ‘embed electronic fit notes in hospital systems’ from spring 2022.

It said: ‘Encouraging hospital doctors to issue fit notes to patients in their care will also further reduce the burden on GPs.’

The document reiterated plans to remove the requirement to sign fit notes in ink from April 2022 and ‘sooner if possible’ and to allow a ‘wider range of eligible professionals’ to sign them ‘at the earliest opportunity’. 

The document also set out further commitments to reduce ‘administrative burdens’ related to DVLA checks and appraisals.

It said: ‘In February this year, a simplified process to renew licences for those with epilepsy and multiple sclerosis was introduced allowing patients to self-declare when there has been stability in their condition with no follow-up with their GP required. 

‘DHSC is working in partnership with the DVLA to expand these changes to other conditions and is looking at opportunities to increase the range of medical professionals that are able to provide DVLA with information.’

NHS England also confirmed that annual GP appraisals – which were ‘refocused’ and ‘simplified’ in October last year – will continue in their ‘less burdensome’ format for the rest of 2021.

Meanwhile, the document also said that NHS England is ‘not intending to reopen previously agreed QOF arrangements and repurpose QOF funding to improve access, for example by substituting new practice-level access metrics such as proportion of face-to-face appointments’. 

But it added that NHS England will commission a new QOF improvement model ‘focused on optimal models of access including triage and appointment type’.

It reiterated that there will be no return to QOF income protection ‘given the importance of the work that QOF incentivises, evidence of its effectiveness set out in the recent QOF review and the reduction in QOF performance during 2020/21’.

The document added that the two postponed PCN service specifications on anticipatory and personalised care will be introduced ‘no later than April 2022’. 

The other two services due to launch this year  – tackling CVD diagnosis and prevention and health inequalities – started this month in a ‘reduced’ form. 

NHS England and the Government promised a bureaucracy review as part of the 2020/21 GP contract, but proposals have so far been met with little fanfare.

A Government consultation on reducing GP bureaucracy was published in November last year.

The ‘support’ package also said that the 20% of practices with the lowest face-face appointment levels will face ‘immediate action’, while patients will rate access to their practice in real-time.

The BMA warned that it is ‘flawed and patient care will suffer as a result’.

Meanwhile, health secretary Sajid Javid refused to meet GPs face to face and instead pulled out of appearing at the RCGP’s annual conference.

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Robert James Andrew Mackenzie Koefman 15 October, 2021 5:31 pm

“Encouraging” hospital doctors will not change anything it should be mandatory in the hospital contracts otherwise nothing will change.

Doc Getmeout 15 October, 2021 5:45 pm

all words but will never be executed – patients always come to GPs and will have to do it to keep your patient happy and non -complaining.

There need to be financial penalties.
As the the Queen said is people who “talk” but “don’t do”,

Dr N 15 October, 2021 5:48 pm

The NHS Trust contract changed in 2019 to deal with this – unfortunately many consultants and registrars don’t appear to have had the memo.

Simon Gilbert 15 October, 2021 7:13 pm

This has been in the hospital contract but 1) it is fine anyway and 2) commissioners in my patch still maintain a long list of exceptions so that if a patient is seen by neurosurgery who want a spinal injection as a therapeutic and diagnostic procedure to inform who might benefit from surgery guess who has to do the pain clinic in the same hospital referral (clue – not the surgeon)?

Beaker . 15 October, 2021 7:21 pm

To SG – that’s clearly not the case as that would be a referral for the same condition – so should be done by the neurosurgeon – sounds like you need to replace you local LMC leadership / team and learn how to say NO

Simon Gilbert 15 October, 2021 9:17 pm

Trust me I raised it in all official channels then received a document dated after 2016 blessed by commissioners that confirmed this.
When commissioners are ignorant of the existing contracts and commission against them it is impossible to get anyone to take responsibility or resolve the situation.

On the plus side after a whole year of dispute with the ophthalmology trust and me chasing NHS specialist commissioning our regional eye unit now arranges surveillance for melanoma metastases themselves rather than leaving it to the GP!

Given it was already mandatory for hospitals to do their own work I have little confidence the above announcement will change anything!

Not on your nelly 16 October, 2021 8:08 am

Exactly, they can say what they like it depends on what local CCGs commission/cajole. In our area the basket of services (huge amount of non-GMS services for 1 pot of money) essentially includes being a secondary care community house officer (sick notes/meds/bloods). Local hospitals are never going to fulfil their contacts while GPs are held over a barrel in this manner.

Dylan Summers 16 October, 2021 10:39 am

The biggest workload dump is in extensive pre-referral workups EG fertility
I doubt there are any plans to address this though.

Darren Tymens 16 October, 2021 12:46 pm

Most of the ‘help’ promised in the ‘rescue package of doom’ is rehashed promises they have not acted in in the past.
This part is no different – it has been part of the hospital contract since 2019. It has just never been enforced. An in house survey carries out by my LMC suggested each DGH breaches around 30K times a year – and yet commissioners do nothing, because reasons. Their shoulders must ache from shrugging so much. Bear in mind 2 GP contract breaches often leads to removal of contract.
It’s almost as if NHSE doesn’t understand or read it’s own contracts.

Nathaniel Dixon 16 October, 2021 1:52 pm

This should already be happening it has been in hospital contract for years and as we all know is terribly enforced. You can only break the same promises so many times before no one believes you anymore

John Glasspool 16 October, 2021 5:11 pm

Flying pigs.

Marie-Louise Irvine 18 October, 2021 10:34 am

heard this 100 times before. Tried to enforce it. Impossible.

Patrufini Duffy 18 October, 2021 2:43 pm

Hospital = glamorous respected tariff
GP = capped hated sledged dumping ground

Sort your ideologies first. They’re perverse.

Simon Gilbert 18 October, 2021 8:20 pm

Phone typo I meant 1) it is done anyway

James Weems 18 October, 2021 8:58 pm

Hands up who believes this hollow promise will result in hospitals doing their own work rather than passing it down to us?