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Charging hospitals for workload dump among ideas discussed by LMCs

GPs with burnout leaving NHS

Imposing financial penalties on hospitals for inappropriate workload dump onto general practice could be one part of the solution in tackling the workload ‘tsunami’ GPs are facing, it has been proposed.

This was one of the ideas local GP leaders discussed at the UK LMCs conference today, during a debate aimed at finding solutions to the ongoing workload issues in general practice. 

Speaking during the debate, Dr Paul Evans, chair of Gateshead and South Tyneside LMC said general practice ‘shouldn’t be taking’ secondary care work, adding that ‘trusts who dump this need to be penalised financially, and they need to be hit hard until they stop doing it’. 

He added: ‘This [issue] is out of the individual GPs control and the LMCs control, although we fight this fight vigorously on behalf of our constituents… and are having some limited success.’

At the end of the debate, the GP leaders also voted in a poll gathering their opinion on various statements, which found that 79% of the 248 respondents strongly disagreed or disagreed that general practice should be accepting more work from secondary care, assuming that it is ‘clinically safe and appropriately funded’.

Other ideas mentioned in the debate included the GPC asking the Government to launch an independent review into the workload in general practice, which has become a ‘health and safety issue’.

GP leaders also supported the idea of capturing practice workload data by introducing a secondary-care style black alert system, which was also suggested in a recent NHS Confederation report.

GP leaders also called this an opportunity to ‘press the reset button on demand and expectation’, adding GPs should be allowed to focus on ‘what we do best’ and to not be dragged into other work best suited to other professionals, and urged for future contract negotiations to reflect this.

Others called for the arrangements allowing patients to directly book into 111 slots in general practice to be ‘renegotiated into oblivion’, the relaxation of QOF, a substantial increase to GP funding and for the GPC to negotiate ‘to allow PCNs to have bottom up decision-making to allow for recruitment of any additional staff’.

The news comes as a recent Pulse survey of GPs showed that two thirds had experienced a ‘significant’ increase in workload dump by hospitals due to the Covid-19 pandemic.

Meanwhile, a report produced by Kent LMC last autumn suggested three million GP appointments could be freed up by ending hospital workload dump on practices.

Poll statements:

A. There is an urgent need to capture practice activity data.

Strongly agree – 66%

Agree – 27%

Slightly agree – 4%

Slightly disagree – 1%

Disagree – 2%

Strongly disagree – 0%

B. Realistic patient expectations of what can be provided by both in hours and out of hours general practice is essential.

Strongly agree – 88%

Agree – 8%

Slightly agree – 2%

Slightly disagree – 0%

Disagree – 1%

Strongly disagree – 1%

C. The benefit to patients by increasing the ways they can access general practice (online consultations, direct booking by urgent care services, etc) outweighs the increase in demand that this creates and the associated workload pressures.

Strongly agree – 14%

Agree – 9%

Slightly agree – 6%

Slightly disagree – 6%

Disagree – 20%

Strongly disagree – 45%

D. All workload discussions must consider the system as a whole and not the needs of either general practice or secondary care in isolation.

Strongly agree – 31%

Agree – 30%

Slightly agree – 9%

Slightly disagree – 8%

Disagree – 12%

Strongly disagree – 10%

E. The interface points between primary, secondary and intermediate care must be formally defined by GPC, not left to LMCs.

Strongly agree – 32%

Agree – 27%

Slightly agree – 15%

Slightly disagree – 7%

Disagree – 12%

Strongly disagree – 7%

F. Assuming that the work is clinically safe, and appropriately funded, general practice should be accepting more work from secondary care.

Strongly agree – 4%

Agree – 6%

Slightly agree – 8%

Slightly disagree – 3%

Disagree – 19%

Strongly disagree – 60%

G. Practices have all the tools they need to control workload, they just need to learn to say no.

Strongly agree – 9%

Agree – 2%

Slightly agree – 9%

Slightly disagree – 7%

Disagree – 23%

Strongly disagree – 50%

Source: BMA


Patrufini Duffy 11 May, 2021 9:53 pm

They want you to refer more. Then somehow you receive more work? Mathematical NHS sense. No tariff ofcourse.