There is no doubt that early discharge from clinics and preventing inter-consultant referrals causes more work for GPs and increases the risk that patients’ concerns will be assessed inappropriately when specialist expertise is required.
The GP reviewing a wound or the post-op condition will not always recognise the significance of problems.
There are also some unnecessary follow-ups which have historically taken place. Some GPs believe the only way to balance budgets is to limit this ‘hospital-generated expenditure’. These GPs are over-represented on clinical commissioning groups and in NHS management.
At first thought, it appears obvious that if GPs do the work for nothing, it will save money for the NHS (the so-called ever-increasing efficiency). However, increased workload for practices does affect their ability to do other non-contracted work, especially as most GPs I speak to feel they are working at or close to their maximum. There are likely to be unforeseen negatives to a transfer of work and responsibility to GPs – to the GP, the practice and patients.
Just as the hospital trust board is not ‘the consultants’, the CCGs are not ‘the GPs’. It is vital that consultants who believe patients need specialist follow-up communicate this to GP colleagues, and that GPs who feel unprepared to deal with difficult cases report these problems too. Work is being dumped on GPs, but it is not, generally, the fault of our esteemed consultant colleagues.
I hope that in the future CCGs will create a notional cost for GP time, which can help them to understand the potential effects of a transfer of workload.
From Dr Nick Chiappe