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Hancock suggests GPs can continue to do secondary care work after pandemic



Health secretary Matt Hancock has signalled that he wants GPs to continue to consult patients who would typically be seen in secondary care – with specialist help – after the Covid-19 pandemic comes to an end.

Mr Hancock made the remarks in a speech about the ‘future of healthcare’ on Thursday, but GP leaders warned that such ‘workload dumping’ would further overstretch general practice and ultimately see practices having to turn patients away.

Speaking at the Royal College of Physicians, the health secretary said: ‘During coronavirus, when many secondary care appointments were cancelled for those with chronic complex conditions, primary care clinicians were able to support them using digital technology to take advice from consultants where needed – so the best possible care could still be delivered in the community.

‘This is the spirit that I want us to channel as we move out of this pandemic.’

In the future NHS, the silos between providers and trusts ‘of all kinds’ must be broken down to prioritise the needs of the patient, Mr Hancock added, including a ‘financial and inspection approach that encourages and rewards collaboration’.

Doncaster LMC medical secretary Dr Dean Eggitt told Pulse that the consequence of this approach will be that people are ‘turned away from general practice’ because GPs are too busy dealing with complex patients.

He said: ‘If you want me to deal with the complex care of a patient who was otherwise managed in a hospital, I’m going to have to turn other people away.’

And patients who are turned away will ‘deteriorate’ and either present late with ‘severe illness’ or ‘rely upon acute services’, Dr Eggitt added.

He told Pulse that without extra resources, this is simply further ‘workload dumping’ from secondary care into practices.

He said: ‘We’re not talking about providing resources to help people deliver care, otherwise that is a shift of work. This is workload dumping, it’s taking from one person and sticking it on someone else’s pile.’

He added: ‘The idea of a specialist giving advice to a primary care clinician on how to best manage a patient is a brilliant model of care. However, it shouldn’t be assumed that we can do that without support and resources.

‘In reality, it’s going to be at the cost of patient health and it’s short-sighted because it’s going to increase costs and burden on acute care services.’

BMA GP Committee chair Dr Richard Vautrey told Pulse that patients must be able to access ‘timely care with the right professional’ as routine services resume.

He said: ‘Going forward, as more routine services open up and there is greater use of remote consultation, the priority must be that patients continue to be able to access timely care with the right professional in a streamlined way.

‘This means both primary and secondary must get the support and resources they need, not least properly commissioned and resourced community services, especially when facing such a large backlog of non-Covid care put on hold by the pandemic.’

Throughout the Covid-19 pandemic, GPs have warned that they are managing more patients ‘outside their comfort zone’ due to increased ‘workload dumping’ from secondary care services.

Last month, an audit by the Royal College of Physicians revealed some specialties could take up to two years to clear their referral backlog – following similar concerns raised by GPs in Liverpool.

And GP leaders warned that hospitals rendered ‘untouchable’ by coronavirus measures were still rejecting around 75% of referrals and ‘reverse delegating’ patients back to their GPs.

At the beginning of the pandemic, NHS England had acknowledged that there would be reduced capacity in secondary care but said that GPs should continue to refer.

Mr Hancock also used his speech to say that unless there is a ‘compelling clinical reason’ to see a patient face to face, all GP consultations should be carried out remotely going forward.

And he pledged that bureaucracy that was removed from the NHS due to Covid-19 will not return.

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