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ICS sets out ‘principles’ to reduce inappropriate hospital/GP workload dump

ics workload principles

Cheshire and Merseyside ICS has produced a consensus document to tackle inappropriate transfer of work between hospitals and GPs.

The set of principles includes that hospital clinicians should avoid asking the GP to organise specialist or blood tests, that whoever orders a test is responsible for its result, fit notes should be provided for the full time needed and onward referrals between specialists should be arranged directly.

For the part of GPs, referrals to secondary care should be clear in their ‘ask’ and appropriate assessments and investigations already done as well as long-term conditions well managed for those waiting for an operation, the document states.

The goal of the consensus document is to improve relationships between colleagues, remove unnecessary administrative burdens and create a more efficient system, the ICS said.

With significant excess demand across the NHS as a result of the pandemic, ‘it is imperative we work together to tackle increasing presentations and lengthening waiting lists’, the document noted.

The principles are supported by leaders in primary and secondary care but there will be exceptions and clinicians ‘are trusted to make appropriate decisions based on individual circumstances’ it added.

Work should also be done to better communicate with patients on waiting lists to ensure they know their referral has been received, how long the wait may be and what to do if their condition deteriorates.

The clinician prescribing a medication is responsible for communicating the need for the treatment, including risks and benefits, and arranging any follow-up needed. And any immediate prescribing needed from outpatients should be done there and then, the consensus document said.

Dr Jonathan Griffiths, a GP in Cheshire who has been working in an advisory role to the ICS, said the consensus came from a task and finish group that had been set up to look at system pressures across the region.

‘We wrote to all healthcare professionals in primary and secondary care and said what would make your lives easier, what would help with the demand and quite a lot of the answers that came back are met by this consensus document.’

He said PCNs, trust medical directors and LMCs were all involved in developing the final version.

‘It’s about trying to help system pressures and it is not about finger pointing but trying to build consensus, trying to build relationships.’

Some of the issues are about clinicians being unaware of what they should be doing as historically they may have been told they could not refer to another consultant, for example, or they have no idea how the current fit note system works, he explained.

The next step will be to get the document in front of everyone who needs to see it, he added.

‘It’s trying to encourage people to do the right thing, rather than beating them with a stick. The difficult bit is the implementation,’ he said.

Cheshire LMC said the principles set out in the document had been well received and work was now being done to put the document into practice and engage with clinical colleagues in other sectors.

As part of last year’s winter support package to general practice, NHS England had told hospitals ‘eliminate unnecessary’ workload transfers.


Dr N 8 July, 2022 4:37 pm

In theory great. In practice never works because the entire profession is now dependent upon locums on both sides of the fence who are understandable clueless about such very localised rules.

This needs to be a national change.

Iain Chalmers 8 July, 2022 6:58 pm

Principles with exceptions, sounds like usual “fudge” with the dump of similar colour IMHO

Clear, simple and applied equally nationwide would be a very significant start but from a mere 28 years GP experience it ain’t going to happen.

Patrufini Duffy 9 July, 2022 9:35 am

The whole point of an ICS and Americanised vertical integration is to command you and remove your autonomy, they took the rug from your foot when you signed up to a data monitoring PCN gimmick, then dump on you like a cattle of deprofessionalised slaves.

Just go to the US to see it in action.

And there you had the 2022 Wonca GP conference in London. In the nation of prosecuted and persecuted family practitioners. Loving it.


Tim Atkinson 11 July, 2022 1:37 pm

This has been going on for decades. Many of the proposals are existing secondary care contractual obligations but they are and will continue to be ignored because a) no sanctions or penalties can be brought against ‘the hospital’ and b) when faced with the inappropriate workload dump it is easier for the GP to simply do it than to enter into arguments with the perpetrator or patient.
Nothing will change until secondary care are forced to pay for the additional work they have created.

Patrufini Duffy 11 July, 2022 2:04 pm

Every GP knows that they are now receiving emails from people with new signatures, names and fancy pants roles. The who on earth are you had begun. New names from the ether, new agendas, old story. Keep filling in your Friends and Family feedback. I would recommend.

David jenkins 13 July, 2022 2:44 pm

on a few occasions i refused to give post op patients a “med3”.

i sent them back to the ward, and told them to phone the local rag if they were refused a med3 from the hospital. i gave them the 20odd page document, signed by tony blair several years ago to take with them.

i explained to the patient that, although i could see a big bandage were they had (apparently) had a knife stuck in them for some operative procedure, i had no idea what they had had done, nor how long they should be off work BECAUSE THEY HAD BEEN SENT HOME WITH NO INFORMATION AT ALL FROM THE HOSPITAL.

after a couple of bolshy phone calls from the registrar (qualified a couple of years vs my 30 years), during the course of which i had to point out the call, and therefore his attitude and bad language, was recorded, the matter went away – but only until there was a change of staff !

write to the hospital manager, explain it is THEIR duty, not yours, threaten them with the LMC (!!), and the press – it certainly won’t make you popular, but if you’ve got all the facts you will eventually get through !!