General practice needs a ‘black alert’ system to flag unsafe workload and help formally document the ‘immense pressure’ the sector is under, a new report has warned.
The move is one of 10 key priorities listed by NHS Confederation to aid the recovery of general practice after the Covid-19 pandemic.
In a report, published today, the representative body said ‘comprehensive measures’ need to be implemented to reduce GP workload, alongside the development of a secondary care-style operational pressures escalation level (OPEL) system to ‘manage work safely’ and to ensure the system recognises current pressures.
The BMA developed an OPEL black alert system in 2018, which suggested a cap of 25-35 routine appointments per day to ensure a ‘safe’ workload for GP practices, however this was never recognised by NHS England and it was unclear how GP practices could put it into practice.
But the NHS Confederation warned that general practice is currently facing ‘an increasing and more complex workload, a tired workforce and the ongoing vaccination programme’.
The report said: ‘During the pandemic, we all saw the level of detail evidencing the pressures on secondary care. While primary care was under immense pressure, we had little evidence to back it up – nothing that measures the rising demand, growing complexity, higher expectations, increased administrative burden and rising thresholds for referral to other parts of the system.’
The report also recommended:
- Ensuring there is clarity on national priorities coupled with analysis of local needs.
- Redefining what services are delivered where – inside and outside primary care – to help reduce duplication and maximise economies of scale, which includes ‘rethinking the whole access agenda by moving to a different model’.
- Focusing on delivering care to the right people at the right time and by the right person to improve health equity, which, in part, requires the Additional Roles Reimbursement Scheme (ARRS) becoming more flexible.
- Investing in management support, estates, IT and digital system to ensure primary care infrastructure is ‘fit for the 21st century’.
- Creating more seamless pathways between primary and secondary care and ensuring better access to community diagnostics.
- Retainaining ‘regulatory permissiveness’, balanced with proper accountability to ensure bureaucracy minimised during the pandemic does not return.
- Addressing disproportionate investment and recognising that ‘to fully embed a patient-centred approach will need different solutions for different groups of the population’.
Commenting on the report, NHS Confederation director of primary care Ruth Rankine said: ‘Primary care is the front door of the NHS and carries out 90% of contact with patients, but the challenges it now faces cannot and should not be underestimated.
‘Rising demand, growing complexity, higher expectations, increased administrative burden and the continued challenge of rolling out the largest ever vaccination programme mean primary care is under immense pressure.’
She added: ‘Much of the public debate has been focused on the strain faced by hospitals, but this needs to change. Primary care leaders are committed to working together and doing everything they possibly can for their patients, but an open and honest discussion needs to be had, coupled with a clear set of achievable priorities. Otherwise, there is the very real risk of care becoming disjointed and services being overwhelmed.’
The report comes as NHS England has signalled it is working on plans to help manage growing GP workload in a way that will also ‘make sense to patients’.
Recent data revealed GPs saw more patients in March than in any other month since records began with the BMA saying this validates GP warnings that they are busier than ever.
And Pulse’s recent workload survey revealed that GPs are working 11-hour days and dealing with an average of 37 patients in that time.