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LMCs to vote on separating acute from planned GP care

LMCs to vote on separating acute from planned GP care

GP representatives will vote on separating acute on-the-day care from planned GP care at the annual conference for England LMCs next month.

The motion in question states that the current general practice workload is ‘unsustainable’, and that separating out acute and planned care should be an ‘essential component’ of the new contract. 

It calls on the BMA’s GP Committee to negotiate a separate service to provide on-the-day acute care for patients who currently get seen by GPs. 

Motion in full

WALTHAM FOREST: That conference believes that the current workload for general practice is unsustainable, and:

(i) believes that the time has come to separate acute on-the-day care from planned general practice care
(ii) insists that the separation of care be an essential component of a new GMS Contract
(iii) requests that GPC England negotiates a separate service for the provision of on-the-day acute care for patients currently seen by GPs.
(iv) requests that GPC England stipulates that a new GMS contract clearly indicates the situations when a patient would benefit from moving between acute care services and planned care services and the mechanism to enable this
(v) requests that GPC England negotiates a new GMS contract which focuses on continuity of care, care of long-term conditions, preventative healthcare and end of life care.

The current five-year GP contract will come to an end in March, meaning the GPC will negotiate with the Government for a new contract which could include more extensive reforms than recent years.

However, NHS England’s primary care director told Pulse in August that they are ‘not in a position’ to negotiate a new five-year deal due to a lack of funding commitment, and the 2024/25 contract will be a ‘stepping stone’.

GP leaders at the LMCs conference will also debate whether all LESs should be scrapped, amidst a range of motions relating to upcoming contract negotiations.

They will also debate a motion to establish a direct enhanced service for implementing an ADHD annual health check, as well as a demand that the BMA’s safe working limit of 25 contacts per day is considered a ‘red line’ in contract negotiations.

One motion proposed that if it takes 20 minutes for GPs to turn on their computers, Steve Barclay should not be investing in ‘robotic penguins’, which are currently being trialled in hospitals to take medicines from pharmacies directly to wards.

Other highlight motions in full

AGENDA COMMITTEE TO BE PROPOSED BY WORCESTERSHIRE: That conference is dismayed by the inconsistent and chaotic approach of NHS England towards delivery of Covid vaccines, particularly the significant reduction in the IOS payment and the changes to vaccination programme timelines, and asks that GPC England:

(i) negotiates with NHSE to ensure that IOS payments for Covid for future years are increased to at least 2022-2023 levels
(ii) negotiates annual inflationary rises for all vaccination IOS payments
(iii) negotiates that general practice is offered terms no less favourable than pharmacies
(iv) demands that, in the future, general practice is given at least six weeks’ notice in advance of any changes in the timeline of the Covid vaccination programme, or additional funding should this lead time not be met
(v) rejects any future vaccinations programmes that have an IOS payment less than previously agreed and will strongly advise the profession to decline signing up.

LEEDS: That conference, in recognition of the increased awareness and identification of ADHD, expected prevalence rates, significant secondary complications and impact on an individual, the NHS, the wider system, and society as a whole; we demand:

(i) the prompt establishment of an NHS England Any Qualified Provider (AQP) list of neurodevelopmental services, including private providers available through NHS Right-to-Choose
(ii) an England-wide self-referral mechanism to a single-point-of-access offering screening and triage to deem “clinical appropriateness” and care-navigation to inform and enable patient choice
(iii) that urgent measures are taken by NHS England to remedy the fact that NHS ADHD Services across all ages in have been chronically underfunded for years
(iv) a direct enhanced service to cover the implementation of an ADHD annual health check, that would also properly fund the workload for ADHD medication shared-care agreements
(v) accredited career pathways in ADHD for interested GPs and other primary-care HCPs, with nationally funded mechanisms to enable the training and subsequent skills to be utilised.

AGENDA COMMITTEE TO BE PROPOSED BY DEVON: That conference asserts that NHS England’s use of the term “arbitrary” when referring to the workload limit is disgraceful and reasserts that the demand pressure on general practice has long since exceeded the threshold of safety, and:

(i) argues that simple quantification of appointments is disingenuous and needs more nuanced classification to reflect clinical complexity and value of time spent

(ii) supports the BMA Safe Working Guidance and calls for safe working limits to be considered a “red line” in contract negotiations, and for wider system overflow support to be mandated where OPEL reporting systems are indicating high levels of demand on practices
(iii) demands that NHS England make suitable provision for all practices across England to divert urgent workload when their daily safe working limits have been reached
(iv) supports a new above-practice triaging service to manage excessive demand on general practice, which must not include the option to refer back to general practice
(v) encourages the establishment of waiting lists for routine GP appointments in order to reveal, and to go some way toward quantifying, this demand and hidden workload.

BUCKINGHAMSHIRE: That conference is appalled to learn of the emerging scandal surrounding the use of reinforced autoclaved aerated concrete (RAAC) in many buildings necessary for public life, and calls on GPC England to demand:

(i) urgent government funded surveys of all primary care estates, to identify any facilities constructed from RAAC
(ii) prompt provision of state funded support for any practice found to have RAAC in order to make it safe either through repair or rebuild
(iii) a public enquiry to investigate why the known dangers of RAAC have been ignored by government for so long.

AGENDA COMMITTEE TO BE PROPOSED BY NEWCASTLE AND NORTH TYNESIDE: That conference believes that Additional Roles Reimbursement Scheme (ARRS) staff have not been nationally supported to develop adequate competence within primary care and:

(i) all ARRS staff should be supervised similarly to GP registrars for three years from commencing their role
(ii) GPC England needs to insist that, as per GMC guidance, levels of supervision should be guided by the needs of the individual rather than a blanket approach
(iii) all ARRS roles and associated supervisors need to have funded and protected time for supervision and learning
(iv) no further push for advanced access whilst the inefficiencies of this model are restructured.

AGENDA COMMITTEE TO BE PROPOSED BY CLEVELAND: That conference is disheartened to note that recruitment and retention of general practice is at its lowest level currently, believes the NHS England Long Term Workforce Plan is a missed opportunity to support retention of GPs and calls for:

(i) removal of the five-year maximum eligibility limit to the NHS England GP Retention Scheme
(ii) levelling up of ICB investment in the NHS England GP Retention Scheme across the country
(iii) increased government investment in the NHS England GP Retention Scheme
(iv) consideration of ways to retain and support GPs further down the line in their careers, so that GPs enjoy their work for longer and avoid burnout and early retirement
(v) all GP retention or fellowship programmes to be open to all GPs on an equitable basis.

GLOUCESTERSHIRE: That conference asks GPC England to seek to establish the absolute minimum number of GPs (by WTE) that are required to meet the basic needs of a standard population size, and collate these statistics, in order to:

(i) provide a dataset that complements and gives context to the new OPEL type GP alert systems being established
(ii) assist the GPC England executive to hold NHS England and the Secretary of State to account when they fail to meet their obligation to ensure the provision of primary care services
(iii) clearly demonstrate the superior quality and value created by traditional general practice compared with corporate and private sector alternatives reliant on ‘GP lite’ models.

DERBYSHIRE: That conference believes that if it takes 20 minutes to switch on your computer in the morning then Steve Barclay should not be investing in robotic penguins.



Please note, only GPs are permitted to add comments to articles

David Church 30 October, 2023 11:28 am

One size does not suit all – neither patients nor doctors !
I have additional training in emergency care and trauma care for provision of all services in a remote rural area, and enjoy doing so.
Proper ‘continuity’ includes all urgent and acute care being provided by the same staff team with knowledge of the patient from long-term care : not every old person who falls can remember that they are taking warfarin and diabetic tablets, or steroids, for example.
It is extremely desireable to RETURN acute care to rural practices such as some of our local ones who have given up on it and tell all patients they have to call 999 or take themselves to a hospital A&E over an hour away by car (more by train/bus, and not at night), when we have a suitable facility in our town, even capable of XRays.
What Rural GP needs is significant increase in resources, including funding to attract suitable staff; and actual increased numbers of fully qualified GPs wanting to work in the area.
It is a lovely area, and work could be very rewarding with a wider range of conditions, but only if sufficient staff to reduce workload pressures.

Nick Mann 30 October, 2023 12:37 pm

Please vote AGAINST Waltham Forest’s LMC motion.
To separate acute and ‘planned’ care is not only an artificial distinction which risks further de-skilling of what future GP trainees may become, it pretends that general practice can be so compartmentalised. Have we forgotten how we actually learned Medicine in the first place?

When mum brings in her toddler with an acute concern – whether physical, behavioural or both – this is a fillip for future management of the child, mother or family. Knowledge, familiarity and trust are limited in isolation.

Certain patients benefit from regular annual checks, but we are mandated by NHSE to do far too many such checks and reviews. We should be able to choose who’s reviewed, how often and by whom. The multiple knock-on benefits accrue to both patient and doctor.

The problem is agency, and the DES is both medically unevidenced and professionally soul-destroying. Vote against that, not against the necessary strands of medical practice which actually make you a decent GP.

Darren Tymens 30 October, 2023 12:44 pm

Although obviously well-intentioned, splitting urgent care and routine care would be a disaster, and quite possibly the end of the GP role in a meaningful sense.
General practice’s unique position is seeing patients holistically, and that means a certain amount of same-day care as well as routine care and chronic disease management – often all in the same appointment.
To try to split things off changes this, to a much more ‘pathways-orientated’ system such as operated in hospitals. This hasn’t really worked in hospitals – it has certainly negatively impacted productivity, cost-effectiveness, accountability and, I think, standards and morale. It does make it easier for NHSE to substitute a range of other, cheaper, HCPs into pathways instead of doctors though.
I want to look after my patients as individuals with a range of needs, not operate a small part of a defined pathway and bounce patients around the system for other aspects of their care.
Of course, whatever happens, the private sector will still offer holistic family doctor old-school care: there are a number of very good reasons for that. LMC reps would do well to reflect on them before voting for this change to NHS practice.

Nicholas Sharvill 30 October, 2023 1:16 pm

Separating acute from chronic care Would anybody choose just to provide ”chronic care” as a career?
Being a Gp with a continuity of care ethos means being available to help for all but those things needing acute secondary care, a very small number per practice. Is acute ear pain in a child, a feverish baby, a flare of colitis or asthma ”acute’ and someone else to sort out. Who decides.? Or is this a plan where the LMC is actually looking for additional funding streams. I am grateful, for those colleagues who sit on LMC but do they have a different wish for their future compared to those who enjoy the mixture that being a GP provides

Cameron Wilson 30 October, 2023 5:53 pm

The acute stuff makes the chronic stuff bearable (just)!
Particularly in rural settings, as per David’s comments, GP’s should be dealing with acute situations, but being appropriately renumerated for their efforts and expertise!

Ray Shrouder 30 October, 2023 6:04 pm

I’m sure we all build acute need into our daily appointment systems.

Surely the issue is unscheduled care when daily capacity has been reached especially from the likes of 111.

These patients could then be directed to overflow hubs.

SUBHASH BHATT 30 October, 2023 9:58 pm

Very sad to hear such motion. We want to be called as specialised gp and want others to do our basic job of caring patients in community. Why would you not deal with acute problem??

Elizabeth Toberty 31 October, 2023 6:55 am

We already struggle with patients with health anxiety…a system like this means they will keep going round and round, rather than anyone trying to work out what’s actually going on.
Also frequent infections can add up to Cancer, who is keeping an eye on that?

Gareth Bryant 31 October, 2023 9:26 am

Another nail in the coffin of General Practice as I understood it – relationship based medicine built on continuity of care. Turkeys voting for Christmas if this is passed.

Andrew Jackson 31 October, 2023 10:08 am

A desperate but terrible motion to try and get a degree of workload control. Need to find another way to do this.

Long Gone 31 October, 2023 2:47 pm

From a perspective of four decades in the NHS including thirty years as a full time GP partner, Primary care has slowly been distancing itself from Acute care.

LOC collapse, status epilepticus, most suspected MI and Stroke, Asthma with severe respiratory distress, crashing LVF and much else once fell within the remit of the GP as “first responder”, even in urban areas. Understandably and quite rightly these presentations now usually require a 999 response; minor injuries are often similarly diverted to A&E or nurse-led MIU. So this proposal might be the logical conclusion of that process, but it probably will be the final nail in the coffin of GP-led primary care. Once any semblance of Acute care is removed, what remains might as well be handed over to PAs. Perhaps that is the plan?

Fay Wilson 1 November, 2023 8:38 pm

The problem is that demand for unscheduled care is outstripping capacity. Moving acute care elsewhere will take disproportionate resources with it and leave a CDM, screening and plbned care service even more underfunded.

It makes more sense for GPs to keep acute care (including exacerbations of chronic disease) and delegate long term care, follow up, screening and chronic disease management to others. This means that acute care is in the hands of the most efficient decision makers while planned care can be planned and delegated to the team. Delegation is likely to promote better use of resources but could also be achieved by outsourcing.

Carrick Richards 17 November, 2023 12:11 pm

We have found UTC, MIU, HVS, ART, frailty teams, Care Home teams practical and helpful. PCD DES has taken alot of these on and it seems that this is the direction of travel intended.