A&G pilot trust urges consultants to reduce GP workload dumping

A major London hospital trust has urged its consultants to ensure they don’t pass on unnecessary work to GPs, while also supporting their primary care colleagues in the face of recent ‘bad press’.

In a letter sent last week, Barts Health NHS Trust’s group chief medical officer Professor Alistair Chesser told consultants they should ‘avoid asking GP surgeries to do things if possible if they lie outside the bounds of the GP contract’.

However, it comes as GPs recently raised concern that Barts may pass on unnecessary workload to GPs in the form of rejected referrals via a far-reaching ‘advice and guidance’ pilot scheme.

Professor Chesser’s letter said: ‘In essence, if we can more easily do the test/ follow up/ check the result / make the referral and it will be better or as good for the patient if we do, then do so. There is a net saving of work for the system and for the patient and by doing so we are protecting each other.’

Barts is also ‘looking at how we can keep patients on the waiting list informed without involving our clinical staff when possible’, he said.

Professor Chesser added that hospital colleagues can ‘help primary care in many ways’, including by being an ‘ally’ in the face of ‘anti-GP’ sentiment.

He said: ‘[GPs] are receiving uncharacteristic bad press from some quarters of the media as you know. This, in addition to long-standing and worsening problems in meeting the demand they face, the expectations of their patients and the stresses of working through this pandemic are damaging morale amongst our valued primary care colleagues.

‘Please actively support our GP colleagues when speaking to your patients – our problems lie in the demands on our systems, not with individual doctors and nurses. And please act as an ally and call out and challenge any “anti GP” statements if you hear them. Such talk can only be harmful as well as being unfair, disrespectful and most likely untrue.’

The trust enjoys ‘fantastic collaboration with [its] primary care colleagues in all sorts of ways, not least outpatient transformation programmes and urgent and emergency care reform’, Professor Chesser added.

He said: ‘I appreciate the pressures are not only in primary care – they lie very much with us as well and we are all feeling it. [But] we will get through this by working together and providing mutual support to all our partners.’

Professor Chesser told Pulse: ‘We recognise the immense contribution made by our GP colleagues. With the whole system under pressure, we know how important it is to support each other. By doing so we will improve the care we provide together for our patients.’

RCGP chair Professor Martin Marshall said the letter was a ‘great example of leadership and top-quality communication’.

He added: ‘There’s never been a more important time for GPs and hospital consultants to work together.’

But it comes as GPs had recently expressed workload concerns over Barts’ ongoing trial requiring GPs to use A&G services before referring patients across 13 specialities.

If successful, it said the measure ‘could become the default’ for all services across the trust’s five London hospitals. 

A local LMC has called for GP practices to be paid £12.50 per A&G episode to resource the extra workload, following an audit to assess its impact.

GPs have warned that A&G is yet another form of ‘workload dumping’ from secondary care and cautioned that patient referrals may be declined in error.