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Renewed calls for GP ‘black alert’ system amid workload spike

GP support

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.

Last February, Devon LMC rolled out a flagging system for GPs to notify their LMC of when they have reached ‘unsustainable and unsafe workload levels’.


John Graham Munro 10 May, 2021 8:58 pm

GPs do not have to work all hours God sends and make themselves ill—–they then are of no use to anyone——but they will soon be able to take their long awaited summer holidays——because a previously redundant locum workforce is at hand——remember them?——-discarded during the pandemic by the very GPs who are ‘cracking up’ — and before those of you comment that I am callous—-well its time to stop pussy-footing around I say!

Patrufini Duffy 10 May, 2021 10:14 pm

Blackened lives matter.
We’ve all got an A* in Maths.
Don’t save the NHS = GP burnout = can’t be bothered to educate public anymore = more referrals = that’s what the lawyers wanted = worse waiting times = Consultants burnout = Consultants leave = people suffer = winter 2021-22 breakdown = you try recruit from anymansland = more complaints = patients want more = more GP burnout = *repeat.

= broken record
= keep the sertraline tap running
= TRIN, tried to call no reply, DNA, blah blah.

Mr Marvellous 10 May, 2021 10:14 pm

“discarded during the pandemic by the very GPs who are ‘cracking up’”

What a bizarre comment.

The whole nature of being a locum is that there is no guarantee of future work, but there is ultimate flexibility and an increased daily rate compared to a salaried GP / employee on a long term contract.

Did you expect GP Partners to employ locums even though there wasn’t work for them to do?

John Graham Munro 11 May, 2021 10:17 am

Mr. Marvellous——–I thought the point was that there was too much work—-even before the pandemic

Mr Marvellous 11 May, 2021 11:48 am

“I thought the point was that there was too much work—-even before the pandemic”

There was, and then the pandemic shifted the requirements and there was (temporarily) less requirement for locum hours as practices were able to largely manage with in-house staffing. Evidently, if locum time was required it would have been booked….

I find it odd to offer your services specifically on an temporary, ad-hoc basis and to then complain about it when you find that practices don’t need your services. Locums can’t expect to have it all ways at once.

DOI: Locum / Salaried GP / Partner at various points in my career.

David jenkins 11 May, 2021 1:03 pm

i gave up a very successful single handed dispensing rural welsh practice in 2007, after i was found to have a haemoglobin of 5. four consultants advised me that i really shouldn’t continue to run my practice singlehandedly, and i should get help. when i asked the LHB (same as PCT in england) for help i was told “either you’re working or you’re not – get on with it” – so i resigned.

i now do locums, and work two days a week – which is what i wanted to do before i resigned.

my former practice was then run by the health board, and subsequently closed by them, leaving a village of 2000 people with no local surgery.

i am now very happy doing locums. i had no work at all for 14 months (isolating due to chest disease), but now i’m back in work. i offered to do admin stuff, but there was no work, so i spent time catching up with all the household and car stuff that had been untouched for years.

i’m not complaining at all. it was my decision to be a locum, knowing the work was hit and miss, and there may be no demand at all.

i now control my own fees, holidays, days off, leisure time, daily hours etc etc etc. i don’t have to deal with people who want to control me, or tell me that a “bank holiday is now a working day because it’s an emergency”, no extended hours, no saturdays sneaking in to catch up, not even any goalposts to move – just go tyo work and see unwell people. heaven !

the downside is that you may end up with nothing to do – and no pay !

such is life, sometimes shit happens, you have to take the rough with the smooth.

remember “nothing comes without a price” !!