Exclusive: Hospitals are routinely ‘dumping’ work in primary care and piling pressure on GPs, with practices spending an average of 10 hours each week chasing up referrals and discharges, according to a major new survey of GPs in London.
The overwhelming majority of GPs who responded to Londonwide LMCs’ largest-ever survey, obtained exclusively by Pulse, said they believe their daily workload is no longer manageable, with many warning that overflow from secondary care – coupled with a ‘box-ticking’ culture of bureaucracy – is contributing to GP burnout.
The crisis will result in GPs ‘voting with their feet’ and quitting the profession unless the problem is addressed, the chief executive of Londonwide LMCs warned.
The survey findings follow Pulse’s report earlier this week that practices across the country are being put under increased pressure as CCGs block hospital
consultants from referring internally for non-urgent conditions and send patients back to their GP to save money.
The poll of 666 GPs in the capital found that 96% believed the extra GP appointments required to re-refer patients who miss hospital appointments ‘causes additional bureaucracy’.
The survey also found:
– 90% of respondents have patients coming to them within five days of hospital discharge with ‘poor or no clinical information’
– 60% of respondents believe some patients are discharged from hospital too soon
– 59% of respondents have seen patients discharged from hospital with insufficient medication
When asked how much time their practice team spends following up referrals and
discharge information in an average week, the average of the responses given was 10 hours. Some 22% of respondents said practice staff typically spend more than 16 hours each week chasing up information from secondary care.
Workload related to poor communication from secondary care was one of the principal causes of increasing pressure on general practice, the Londonwide LMCs analysis found, with other factors a rise in administration and bureaucracy, mounting patient demand and a lack of resources.
Some 86% of GPs disagreed with the statement ‘I feel my daily workload is manageable’, while 83% said they thought their current workload was ‘unsustainable’. Nine out of ten said their practices were understaffed but felt they could not afford to recruit.
One GP commented: ‘I dislike admitting this and historically I have been able to soak up whatever was demanded from me – I have thoroughly enjoyed my career as a GP, I enjoy my contact with patients. But the current demands of boxes to tick and non-patient-facing tasks is overwhelming and ultimately unmanageable.’
Another added: ‘There is so much more administrative work and more and more meetings to attend, that it seems less time is available for patient care.’
Londonwide LMCs chief executive Dr Michelle Drage told Pulse: ‘GPs will walk. There´s a risk of people throwing the towel in at retirement and before and the system becoming totally unworkable.’
She added that hospital behaviours such as failure to provide adequate discharge information were having a ‘huge impact’ on primary care.
She said: ‘Discharge summaries are few and far between – and bad when they are. Dumping of prescribing is frequent and frustrating. What this says to me is that people need to stop commissioning for secondary care and commission for primary care.’