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.’
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.