We are contractually obliged to do everything, now
Copperfield on the implication of embedding advice and guidance into core practice through the 2026/27 GP contract
I’d love to have a ‘told you so’ gloat here. For ages, I’ve been banging on that the only way out of the GP doldrums is for the Government to strip out urgent care from core – like they did, gloriously, with OOH years ago. But I’m having the opposite of a gloat. Because the new iteration of the contract not only reaffirms our role in urgent care, it doubles down by insisting acute cases all need to be dealt with ‘on the day’.
So much for my carefully constructed argument that GPs currently have two full time jobs each: acute care and everything else. And that ‘everything else’ includes chronic disease, subacute illness, cancer referrals, primary and secondary CV prevention, screening, health promotion, immunisations, fixing radiators et al. So, by two jobs, I mean 27.
This clearly hasn’t washed with the Government. How we’ll cope with this new contractual demand remains to be seen. The wording that clinically urgent requests ‘must be dealt with on the same day’ is open to interpretation. Ominously, later in the same contractual letter, it refers to the ‘requirement to see all clinically urgent patients on the same day’ (my bold/italics). Which could be lazy editing, or the exact opposite.
But the urgent care bombshell isn’t the only incendiary device in this package. The most explosive would appear to be the under-the-radar embedding of A&G into core.
I quote, ‘Practices will be required to use A&G prior to or in place of a planned care referral where clinically appropriate’. That translates, to me, as mandated A&G, given that, on a practical level, ‘clinical appropriateness’ will be refereed at the secondary care end.
This causes so many problems, not least the implication that we can take on the extra work A&G inevitably dumps on us, despite it being beyond our primary care role. Meanwhile, the letter states that, for A&G: ‘NHS England is asking trusts to work towards achieving national operational processing standards.’ So, no imposition on secondary care then. After all, they’re busy. Or on strike.
So welcome to our 28th job. Why not go the whole hog and just make us contractually obliged for everything, now?
Sigh. The traditional ability to refer when needed, without impediment, has so many benefits. One of the most important is the way it acts as a safety valve for us GPs. To lose that and replace it with yet more work and increased medicolegal risk is a genuine existential threat. If I’m right about this one, I promise not to gloat.
Dr Tony Copperfield is a GP in Essex
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READERS' COMMENTS [9]
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So what does “clinically urgent” even mean?
It is rare that I see anything as a GP that could not have waited until tomorrow (or next week).
Nearly everything genuinely so urgent that can’t wait until tomorrow falls into the go to A+E category.
(There are a few obvious exceptions – eg. urgent palliative care symptom control).
Oh and I did actually fix an elderly patient’s broken toilet flush on a home visit not long ago, maybe do radiator next time…
The government is obsessed with reducing pressure in hospital at the expense of primary care. Surely not looking after the gatekeeper will have the opposite effect!
We’ve been using patchs AI since 1st October- the amount of requests that the AI software deems urgent/emergency is ridiculous, these get passed to our on-call dr to review, and invariably these then go back on the routine pile of work to address. Talking about piles, this usually gets assigned as urgent/emergency too, even despite it having been a chronic problem. The AI software has a long way to go still but it is signposting patients directly to A&E a lot more than experienced GPs that know their patients would do, so that’s will increase A&E demand. We’ve found that patients are manipulating the online tools – they may have been signposted to A&E by the software initially and so they resubmit a request with different answers so as not to be signposted to A&E! They’re getting wise as to how to get around the system. I’m sure we can develop systems to deal with these challenges, as we’ve had to do with each new contract
DHSC headquarters
Wes: Right guys, you did what I asked? Remember, screw these f**kers, we want them out of business. A.S.A.P. Amanda, well done, you sneaked in the a&g, let’s hope they don’t notice…wait, so what if they do…what’re they gonna do about it? Cry to the BMA 🤣…Stephen, good bald thinking, bamboozle with numbers….make it look like there’s new money in the contract…Claaaire, good idea – tinkering with the QoF thresholds….make it look important! Well done guys, absoluuutely great job.
Hey, can we get the word “moist” into the contract? Jim, get “moist” in there.
Communist systems eventually have to govern by fiat decree. The tractor quota has risen!
At the moment, secondary care is too big to fail and they’re having to chuck a load of money to more or less standstill with regards to waiting lists
Silly boy, Wes Streeting pushes ahead with major organisation of the NHS without a workforce plan people or funding planning and what’s the betting they will need those people in management let go from NHSE and ICB at some point in the future?
@simongilbert – it’s far right Trumpian (or fascist) diktat. Not communist fiat.
Communism failed and died in 1991. Since when, the rise of neoliberal economics (mutating into a far right authoritarian centralised fascism) has employed tactics to run down our public goods over the last couple of decades.
By the way, you can tell fascists by their lack of humour….and tendency to goose-step.
Why are we so subservient? We can’t possibly do all that is dumped on us. So don’t try to. They can’t sack all of us.
This from the same government to impose greater expectation of referral via bashing GPs with Jess’ rule.
Couldn’t make it up.