Exclusive: Hospitals ignore guidance and continue to dump work on GPs

NHS hospitals are ignoring changes to their standard contract that were intended to stop them dumping work on GPs, a GPonline poll suggests.

NHS England guidance published alongside the 2016/17 NHS standard contract highlighted a series of updates to ease GP workload by preventing hospitals from forcing practices to re-refer patients unnecessarily, or to prescribe medication on behalf of hospital doctors.

The changes also aimed to push hospitals into sending discharge letters promptly and in convenient electronic form. But a GPonline poll suggests that many hospitals are continuing to ignore the requirements set out in their contract.

GP referral

Of 320 GPs who took part in the survey, 73% said hospitals in their area operate blanket policies under which patients who miss hospital appointments are automatically discharged back to the care of their GP. These policies remain in place despite guidance from NHS England that specifies: 'Hospitals will not be able to adopt blanket policies under which all patients who do not attend clinic are automatically discharged back to their GP.'

Guidance also requires hospitals to send discharge summaries electronically within 24 hours after inpatient, day case or A&E care. Just 2% of GPs said trusts they deal with always issue discharge summaries within 24 hours, and about three in 10 said they do so less than half of the time.

A total of 84% of GPs said that when patients they have referred to hospital need medication after discharge from inpatient or day case treatment, local hospitals sometimes expect GPs to prescribe this medication, despite a requirement for hospitals to provide medication to patients who need it after inpatient or daycase care.

Around one in nine GPs said that hospitals they deal with comply less than half of the time with a requirement to ensure that patients they discharge who need medication after a procedure have enough to last seven days.

In addition, 15% of GPs said hospitals do not send discharge summaries electronically.

Discharge summary

A letter sent by NHS England to CCGs and NHS trusts on 28 July suggests that health service officials are aware that the contract guidance is being ignored.

The letter highlights six new requirements for hospitals 'introduced in the 2016/17 NHS standard contract to clarify the expectations across the hospital and general practice interface and reduce avoidable extra workload for GPs and help release time'.

It adds: 'It is important that they are fully implemented in a robust and timely way and we urge you to do this.'

GPC chairman Dr Chaand Nagpaul warned at the BMA annual representative meeting earlier this year that 'the explicit wholesale transfer of care out of hospital continues unabated'. He told the conference that it was 'GPs who’re absorbing this burgeoning workload, with 70m more patients seeing us annually compared to seven years ago and with fewer GPs per head, which is drowning our capacity to cope'.

One GP who took part in the survey said: 'We have a high proportion of patients who do not read or speak English. They are discharged after one non-attendance and the expectation is that we re-refer. Many departments now send out contact letters with a phone number for the patient to ring to make an appointment.

GP workload

'This is creates a real difficulty for our non English speakers and patients frequently attend appointments or reception asking for help to book their appointment. Needless to say, we receive no additional funding for this increased burden of work.'

Another wrote: 'Incredibly frequently, patients complain that the first thing they knew about having an appointment was a letter telling them that they had missed it. When phoning up the hospital, looking for some common sense, they are simply told they need to be re-referred.'

An NHS England spokesman said: 'Recent changes in the NHS standard contract set out clear legal requirements aimed at cutting the burden of bureaucracy on GPs, which is not good for local health services or patients.

'These changes must be driven at a local level by CCGs, working with their hospital colleagues. NHS England, together with NHS Improvement, has written to all NHS trusts, foundation trusts and CCGs to emphasise these requirements as we implement the support measures set out in the GP Forward View.'

Photo: iStock

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