GPs could be asked to review hospital waiting lists for elective care to help prioritise and manage patients from April, NHS England has suggested.
New operational guidance for 2021/22, published at the end of last week, said primary care will be involved in ‘clinically-led, patient-focused reviews’ of secondary care waiting lists to ensure ‘effective prioritisation and manage clinical risk’ from April.
The guidance also formalised plans for GPs to ‘treat more patients without the need for an onward referral’.
And NHS England said that all practices should deliver ‘appropriate pre-pandemic appointment levels’, including a reminder to offer face-to-face appointments.
It comes as NHS England board papers revealed that practices are delivering one million more GP appointments per week than before the pandemic.
The guidance said: ‘Systems are asked to rapidly draw up delivery plans across elective inpatient, outpatient and diagnostic services for adults and children (including specialised services) for April 2021 to September 2021 that… incorporate clinically led, patient-focused reviews and validation of the waiting list on an ongoing basis, to ensure effective prioritisation and manage clinical risk (drawing on both primary and secondary care)’.
Pulse has asked NHS England for clarification, but it remains unclear exactly how primary care will be expected to be involved.
A related implementation guidance document added that local systems must ‘take all possible steps to avoid outpatient attendances of low clinical value’, including managing more patients in primary care.
It said systems must ‘demonstrate progress’ in ‘collaborating across primary and secondary care to treat more patients without the need for an onward referral, including increasing the uptake of advice and guidance or other measures such as referral triage to avoid unnecessary first attendances’.
In September, NHS England indicated it wants to ‘maximise opportunity’ in the management of patients in primary care via advice and guidance services to keep patients away from hospitals.
However, GPs previously warned that this approach amounted to ‘workload dumping’ and could lead to people being ‘turned away from general practice’ because GPs are too busy dealing with complex patients.
Mid Mersey LMC medical secretary Dr Ivan Camphor told Pulse that any move asking GPs to review waiting lists would be ‘over the top and quite unacceptable given the current climate’.
He said: ‘General practice is already over-burdened with a lot of work we’re doing, including Covid.
‘I would love to help my secondary care colleagues, but I just haven’t got enough time in the day to do that.’
Meanwhile, the operational guidance reiterated that GP appointment volumes ‘remain high’ but said GPs should be supported with ‘access challenges’ so that ’all practices are delivering appropriate pre-pandemic appointment levels’.
‘This includes all practices offering face-to-face consultations’, it added.
Practices should also be supported to ‘increase significantly the use of online consultations, as part of embedding total triage’, it said.
Walsall LMC medical secretary Dr Uzma Ahmad added that suggestions that practices are not already working at more than pre-pandemic levels are ‘not valid anymore’.
She said: ‘Our activity is really high at the moment already. There isn’t going to be much capacity – we will definitely be working above pandemic levels and they need to look into how they are going to support that.’
GP access caused controversy in the autumn amid suggestions that practices were not ‘open’ and ‘GP-bashing’ in the media.
In September, NHS England landed itself in hot water with a previous ‘reminder’ to practices to offer face-to-face consultations despite the ongoing pandemic and its own ‘total triage’ advice.
The health secretary has previously indicated that GPs should continue current levels of remote consulting after the pandemic.
READERS' COMMENTS [10]
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1. We’re busy enough thanks.
2. HOSPITALS should review HOSPITAL waiting lists – the clue is in the name.
That is all.
NHSE don’t appear to understand either the GP contract, or the capacity issues we face, or the workload issues we face: they are entirely hospital-centred in their approach.
Of course hospitals want to divest themselves of outpatient work, now that they are no longer paid by PBR but by lump sum: they get to keep the funding whatever.
Of course hospitals want someone else to take responsibility for the outpatients mess they are now in – but, as sympathetic as I am to their very significant acute medicine and ITU Covid challenges, why could they not have run 60-80% of outpatients remotely through the crisis in the same way that we had to run general practice? The barriers to this they faced were not significantly different to ours. Why couldn’t they have reviewed their own lists during this period, rather than expect us to do it for them now?
Contractually of course this would not be core work and would need funding, and would be voluntary (under a DES or LCS or similar) – so if you are told to do it, just say no and ask the commissioner where your contract says you have to do this hospital work.
Capacity-wise, returning to pre-pandemic levels would probably mean reducing appointments for many practices, as levels of appointments are in many places are currently much higher.
It is clear that an attempt to dump workload in general practice is ongoing. Time for GPC and the BMA to step up and stop us being overwhelmed.
Totally agree with previous.
Very little elective surgery is still taking place in hospitals, despite low numbers of inpatients with Covid at the minute, and sub 100% bed capacity – and waiting lists are building still. We are all busy.
As GPs will have to work hard to get through our own backlog of monitoring, diagnosis, and management of chronically ill patients- so too will hospitals.
We can’t prioritise their waiting lists -as we don’t know who else is on them, or whether our patient is more or less needy. That is a job they will need to do themselves.
The main solution is increasing surgical productivity, and assessing patients in person as we have been doing throughout.
So NHSE wants us to offer 1 million less appointments per week ASAP! sounds fine to me!
But where should we tell the patients to phone?
03000 840004? or 111?
I have just reviewed our local NHS waiting lists with a patient-focussed and clinical management viewpoint :
They are too long.
Now, when will all those patients get seen then?
Are hospitals offering as many appointments ase pre-pandemic yet?
just say no–and be very impolite
dear (insert name here)
i referred (insert name here) to you on (insert date here). he/she has not been seen. so far as i’m aware his/her (delete as applicable) condition is unchanged/worse.
please can you deal with this request as per original letter.
p.s. i have not seen him/her for review specifically as, like you, i am trying to catch up with pre-covid work that has not gone away or lessened during the pandemic, despite our surgery remaining open.
yours etc
I suggest a PhD research idea – the correlation between GP morale, NHS + GMC “codes of practice”, patient want and patient comes first, and referral rates.
It’s not that hard to see what this sick system is playing at. Chirades.
Bad as it is,
ICSs are setting up on the premise that Hospitals are special
and need ever more money.
Whilst General Practice must see all the patients and have no say in explaining what will happen. Community services also are expected to ‘just happen’ and mop up ever more work.
“Regional supervisors to help factories catch up with tractor production backlog.”