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More restrictions placed on hospitals for dumping work on GPs



The hospital standard contract for 2017/18 has been updated to include more stringent restrictions on dumping workload onto GP practices.

This includes, as revealed at last month’s Pulse Live conference, fit notes being provided by hospital medics rather than the patient’s GP.

The new contract also sets out that it is the responsibility of hospital trusts to ‘respond to patient queries for matters relating to their care rather than asking the patient to contact their GP’.

It also sets out that:

  • Shared care arrangements must be explicitly agreed first by the GP, and may be funded via a LES;
  • Hospital clinic letters must be received within 10 days from this month, and within seven days as of April 2018 (down from 14 days under the 2016/17 contract);
  • Hospitals must issue medication following outpatient attendance to at least cover the patient until the GP receives the clinic letter.

The amendments follow the introduction of workload protection for GPs in last year’s hospital standard contract, taking them further.

But it comes as a Pulse investigation found that not a single hospital has been sanctioned for GP workload dump despite the changes made to last year’s contract.

Alongside the announcement of the changes, the GPC has published a range of template letters and resources to help ensure hospitals adhere to the contract.

GPC chair Dr Chaand Nagpaul said the changes come as the Government ‘has listened’ to the demands set out in the GPC’s Urgent Prescription for General Practice.

He added: ‘Our range of resources for GP practices will help them make this policy commitment a reality on the ground by giving them the tools to ensure any inappropriate workload is directed back to where it belongs, as well as reporting breaches so that CCGs can take appropriate action.

‘We will continue to place pressure on CCGs and secondary care managers to ensure they are meeting these new contractual responsibilities so that the hospitals and GP practices can deliver a better, more efficient service in which patients do not suffer at the hands of administrative hurdles and bureaucracy.’

Changes to the the hospital contract 2017-2019

  • Hospitals to issue Fit Notes, covering the full period until the date by which it is anticipated that the patient will have recovered.
  • Hospital Trusts to respond to patient queries for matters relating to their care rather than asking the patient to contact their GP.
  • Hospitals must not transfer management under shared care unless with prior agreement with the GP. GPs should not therefore be asked to prescribe specialist medications by virtue of a hospital letter or instruction alone. Any such shared care arrangement must be explicitly agreed first by the GP based on if s/he feels competent to do so, and which may include being resourced to do this as a locally commissioned service.
  • Hospital clinic letters to be received by the GP within 10 days from 1 April 2017, and within seven days from 1 April 2018.
  • Issuing medication following outpatient attendance at least sufficient to meet the patient’s immediate clinical needs until their GP receives the relevant clinic letter and can prescribe accordingly. 

Source: BMA