More than four in ten GPs say their workload has increased as a result of people using more private healthcare.
In all, 46% of GPs responding to a Pulse survey said they were doing more work as a result of patients opting for private healthcare.
Some reported being expected to provide follow-up care after patients had paid for fertility treatment or surgery abroad.
Others said poor shared care arrangements were generating more workload as GPs are expected to take on prescribing and monitoring, with ADHD being a particular issue.
Dr David Coleman, a GP in Doncaster, said private ADHD queries alone seemed to be generating a ‘couple of hours extra work every week for the practice at the moment’.
Interpreting tests done privately, expediting referral letters and organising bloods and scans when private providers had not done them were also listed by those answering the survey as ways their workload was creeping up.
Patients could also get disgruntled if the GP refused to do unnecessary tests or prescribe unlicensed medications, one respondent said.
In total, one in ten said their workload had significantly increased and 311 of the 860 respondents said it was causing a slight increase in work.
During the LMCs annual conference in May, local GP leaders called for practices to be remunerated appropriately for requests from private healthcare or insurance providers relating to their patients.
A Pulse investigation last year found private health services were thriving as a result of long NHS waiting lists with demand for self-pay healthcare rocketing.
Dr Nigel Fraser, a GP in Herefordshire, said he had seen a rise in workload related to private healthcare use but some specialities were more of an issue than others.
In his experience, private ADHD and gender dysphoria clinics were causing a ‘great deal’ of added workload because of poor shared care arrangements.
‘The issues about poor shared care are not limited to ADHD and gender dysphoria but private providers in this area are repeat offenders,’ he said.
He added that issues GPs faced included that diagnosis may not have been done in line with NICE or best practice guidelines and that organisations were often unregulated.
In addition, there were issues with companies wanting to share care corporately and not via a named specialist and not seeking local approval of shared care guidance.
‘Whilst falling short in above they often paint the responsible GP as the villain with the patient,’ he said.
Dr Emma Nash, a GP in Portchester, Hampshire has also seen a massive increase in workload related to private healthcare. ‘Private providers often ask to arrange investigations or prescribe because patients are self-funding. Requesting tests is more than just ticking boxes – we become legally responsible for reviewing, interpreting and acting on results which is time-consuming. Although we are not obliged to do these tests or prescriptions, it can be very difficult when a patient has been told what to expect.’
She agreed that ADHD was a particular issue where GPs end up in a very tough situation as the correct thing is to not prescribe without shared care in place.
‘Private bariatric surgery is a nightmare too. NHS includes a couple of years follow up and monitoring and advice but privately we’re on our own as often patients don’t realise the package may not include the monitoring and don’t want to, or can’t afford to, pay more.’
Dr Zishan Syed, a GP in Kent, said: ‘NHS general practice is being abused and subsidising lucrative private practice that is charging patients extortionate fees whilst expecting GPs to soak up the complicated administrative work pro bono. This is ridiculous and makes a farce of the NHS and the tax payer.
‘It is risible when an NHS consultant works in the private sector and expects NHS GPs to do the administrative work of rereferring back to their own NHS clinic with the pathetic excuse that they don’t have the means or IT to do so in 2023.’
He added: ‘NHS England guidance about the private and NHS interface is laughable permitting patients to hop in and out of private and NHS care so much so that any limited protections it claims the NHS has all but evaporates. If the government plans to use more private sector work to deal with Covid backlog, NHS GPs will be swamped with administrative work from that sector.’
Dr David Wrigley, deputy chair of BMA’s England GP committee, said the NHS backlog is being driven by a ‘a combination of chronic underfunding and a lack of focus on retention’ adding that ‘understandably’ patients on ‘very long waiting lists’, who are ‘often in pain and distress’, are ‘considering if they can be seen sooner by paying for treatment’.
‘We would urge patients considering this to check that the doctor is qualified, will provide follow-up care and ideally a member of a professional association, which makes sure they have the relevant qualifications, experience and insurance,’ he said.
‘As the doctors tasked with managing the care of patients’ conditions in communities, we know long waiting lists means that patients rely even more on their GP as their needs can become more acute and complex the longer they wait.’
Adding that the BMA has ‘developed guidance for GPs to help reduce any extra workload that may be generated by requests from private providers’, he said it is ‘on our leaders to listen to doctors’ and ‘do all they can to tackle the waiting lists without burning out the NHS’ greatest resource, its staff’.
RCGP chair Professor Kamila Hawthorne said that ‘no patient should need to pay for care and services that they are entitled to free of charge on the NHS’ and that ‘we must guard against creating a two-tier system that favours those who can afford to pay and disadvantages those who can’t’.
‘This survey shows the consequences if things go wrong and how this can add to the pressures on hardworking GPs and hospital staff, rather than alleviating them.
‘Many private clinics pass back results to the NHS, often via general practice, to be assessed and followed up. Some private companies routinely advise clients to routinely speak with their NHS GP about their results or treatment, even when this has gone well, further adding to workload and leaving other patients facing even longer waiting times for a GP appointment.’
And she warned this comes as ‘GPs are buckling under the strain of more than a decade of under-investment and poor workforce planning’.
Pulse’s survey was open between 9 and 15 June 2023, collating responses using the SurveyMonkey tool. A total of 860 GPs from across the UK responded to the specific question. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a £250 John Lewis voucher as an incentive to complete the survey. The survey is unweighted, and we do not claim this to be scientific – only a snapshot of the GP population.