Exclusive An LMC has called for GP practices to be paid £12.50 per advice and guidance (A&G) episode to resource the extra workload.
The bid comes amid a national drive to increase the use of A&G to reduce GP referrals to secondary care, by enabling GPs to care for the patient instead of a hospital specialist.
In a letter to Barts Health NHS Trust and NHS North East London (NEL) CCG, sent last week and seen by Pulse, Tower Hamlets LMC said that an audit carried out in August assessed the ‘impact’ of A&G services on practices.
The audit showed that each A&G episode takes each practice 13 minutes ‘on average’ – seven minutes of GP time and five minutes of GP staff admin time – it said.
The LMC has been ‘clear in all discussions that general practice cannot take on extra work unless the resources follow to support it’, it added.
NHS England has set an A&G target across the country in a bid to curb GP referrals to hospitals, which requires GPs to use A&G for 12 out of 100 outpatient attendances by March next year.
But Barts has launched a more far-reaching trial requiring GPs to use A&G services before referring patients, with the potential for this to become a permanent measure.
The letter said that while ‘many’ GPs ‘like the opportunity to manage more complex patients that would normally be seen in secondary care and feel that this enhances their professional development’, the ‘flip side is that managing such patients increases GP workload and the risk we hold’.
It added: ‘We have estimated that the cost to general practice is £12.50 per advice and guidance episode.
‘We understand that Barts has development money available for this project and assume that general practice will be recompensed for this work from this pot? If not, please could the CCG let us know how we will be paid?’
A spokesperson for NHS NEL CCG told Pulse: ‘We are in regular discussion with our GPs about appropriate funding for work undertaken in primary care and we are currently assessing how they can be best be supported to make greater use of advice and guidance services (A&G).
‘Northeast London clinicians have led the way in adopting A&G during the pandemic and are fully supportive of the benefits. This approach is crucial to getting patients access to the information and support they need, in the most appropriate setting, as quickly as possible.’
Barts Health NHS Trust declined to comment.
Pulse has also approached NHS England for comment.
Tower Hamlets LMC chair Dr Jackie Applebee told Pulse that it is ‘ludicrous’ to expect GPs to take extra work unresourced, especially when they are already ‘drowning’.
She said: ‘It is just ludicrous – as if we’re not drowning. We know the hospitals are under pressure, don’t get me wrong, but there are some things that we could quite easily manage in general practice with a bit of support.
‘But expecting us to take all that on when at the moment we can barely do the day job is ludicrous. It’s just completely mad.’
The push back comes as Pulse last week revealed that another major London CCG has set out an aim to cut GP referrals by 65% across seven major hospital trusts through A&G services.
The LMC said it has been having ‘productive meetings with respect to the national expectation to roll out advice and guidance’.
GP leaders have also previously raised concerns that A&G is yet another form of ‘workload dumping’ from secondary care and cautioned that patient referrals may be declined in error.