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Secondary care workload dump ‘equivalent to work of 1,150 full-time GPs’

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A workload analysis carried out by LMCs has shown that work transferred from secondary would take an additional 1,150 full-time GPs across England to complete.

Bedfordshire and Hertfordshire LMCs, alongside Cambridgeshire LMCs, also found that workload being passed from acute trusts to practices is increasing.

The LMCs analysed the data of 109 practices responding to a survey in October, finding that 95% had received requests to complete work from acute trusts.

Their report said that GPs are spending ‘around 5%’ of their time on work that would usually be done in secondary care but had been passed to them by trusts.

It said: ‘This represents a significant shift in workload, with a practice with a list size of 10,000 patients requiring an average of 8.6 hours of GP time to complete this work.

‘If the level of work from acute trusts was reflective of the picture nationally, an additional 1,156 full-time GPs would be required across England.’

GPs and their teams ‘are left feeling they have become “community house officers”’, it added.

Blood tests and prescriptions were the most common requests made of practices, while Advice & Guidance and ‘requests to expedite original referrals’ were the areas where practices had seen the biggest increase in workload transfer.

The report said that GPs were also facing ‘impossible’ requests to facilitate radiology and re-referrals, leading to ‘confrontation with patients that the GPs have to manage, despite it being no fault of their own’.

It also found that:

  • 78% of practices consider the additional workload to be ‘unsafe’ for patient care;
  • 87% feel ‘under pressure’ from their local trust to undertake additional work, which is ‘risking system partnership working’;
  • 93% say workload transfer is having ‘a detrimental effect upon morale’.

The report said: ‘The drop in morale, sadly enhanced by recent media headlines, later compounded by NHS England, has led to a feeling amongst the general practice workforce that they are unsupported and unvalued. This is significantly impacting on resilience in general practice whilst adding to the Covid-19 fatigue. 

‘Recent negotiations around provisions for the Covid vaccination programme have only served to underline this point. Put simply, the status quo is damaging the fundamental part of our NHS that keeps our systems viable. It has to change.’

Aside from ‘workload overload, burnout and fatigue’ among staff, patient access to practices could be reduced due to a ‘lack of resource’ and lead to additional A&E attendances, it added. 

The LMCs called on STP and ICS boards to ‘decide how they will fund the staff undertaking this transfer of work, how they will protect practices by changing their processes, or a balance of the two’. 

It comes as a hospital trust has admitted that it has been dumping additional workload on GPs during the pandemic.

In a message seen by Pulse, Dr Jennifer Hill, deputy medical director of Sheffield Teaching Hospitals NHS Foundation Trust (STH), warned colleagues that GPs have ‘picked up a significant amount of extra work’ from the secondary care system she is responsible for.

Respiratory consultant Dr Hill said: ‘Covid-19 has not only stretched our services, [it] is also causing a great deal of strain to our GP colleagues. It seems that new pathways which seek to minimise face to face patient visits to STH have inadvertently worsened the strain on general practice. 

‘GPs have picked up a significant amount of extra work from us. They have sent the MD office multiple examples from a wide range of GP practices of inappropriate activities being transferred to primary care.’

Dr Hill noted that ‘many’ of her colleagues’ transfers have been made in ‘good faith’ and ‘the spirit of trying to minimise patients’ risk of coming into contact’ with the virus. 

However, she said they are ‘breaches of the contractual obligations’ around what they ‘should be doing and may ask GPs to do’.

The notice outlined a series of actions, including that both clinically urgent and non-urgent problems ‘may and should be referred direct to another consultant if greater holistic knowledge of the patient than the GP may have is not needed to decide on the referral, among other factors’.

Pulse has contacted Sheffield LMC, NHS Sheffield Teaching Hospitals Trust and the BMA for comment.


A non 17 December, 2020 5:40 pm

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