Hospitals told to stop wasting millions of appointments by dumping work on GPs

GP leaders have warned hospitals to adhere to clauses in their contracts that ban work being dumped on practices, as the NHS published new guidance on the interface between primary and secondary care.

Acting GPC chair Dr Richard Vautrey: GPs face unprecedented pressure
Acting GPC chair Dr Richard Vautrey: GPs face unprecedented pressure

Guidance to improve how hospitals and primary care work together spells out rules around referrals to secondary care, how hospitals should manage DNAs, discharge summaries and other issues.

GP leaders have said that work dumped on GP practices by hospitals wastes around 15m appointments a year - more than 4% of all consultations provided annually in England.

Outgoing GPC chair Dr Chaand Nagpaul hailed in his speech at this year's LMCs conference 'hard-won contractual levers' inserted into hospital contracts to stop work being transferred unnecessarily to general practice.

GP workload

Clauses now in standard hospital contracts ban hospitals from automatically sending patients who miss appointments back to their GP, and make clear that hospitals can pass patients on to other departments without first requiring a further GP appointment.

The contracts now also spell out requirements for hospitals to give clear discharge summaries, stop requiring practices to carry out follow up tests on patients, to provide patients with proper medication for a minimum period after hospital treatment and to complete fit notes.

Acting GPC chair Dr Richard Vautrey said: 'General practice is facing unprecedented and mounting pressure from rising patient demand and widespread staff shortages. A significant extra burden is resulting from inappropriate and unnecessary work being transferred to general practice from secondary care settings.

'Doctors and patients alike are frustrated that old-fashioned systems prevent patients from being able to contact the hospital directly to rebook a missed appointment or to receive a fit note from a hospital doctor when they are unable to work. Instead 15m unnecessary appointments are made with GPs to deal with these and other issues when they could easily be dealt with in other parts of the NHS. At a time when GP services are struggling to provide enough appointments to the public this out of date bureaucracy is unacceptable.

Hospital contracts

'Following significant pressure by the BMA's GP committee, this new guidance provides clear national requirements that NHS managers and clinicians should follow to reduce inappropriate workload and by doing so deliver a better service to our patients. It’s now imperative that NHS managers stick to their obligations which are laid out here and in recent changes to hospital contracts. Improving patient care is at the centre of this work as when implemented these measures will make the delivery of appointments and care much smoother for the patient.'

GP leaders warned last year that hospitals were continuing to ignore clauses in their contracts meant to prevent workload dumping on practices.

The GPC hailed an update to the contract that took effect from 1 April this year, and published template letters to help practices push back against hospitals that continued to dump work on GPs.

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