Viewpoint: Dr Beth McCarron-Nash: Consider working with others to safely manage workload

This year's pay recommendations from the DDRB are another disappointing example of how the powers that be have still not woken up to the incredible pressure GP practices are under writes GPC negotiator Dr Beth McCarron-Nash.

Dr McCarron-Nash: 'Maximising the time we have with patients to put across key messages.'
Dr McCarron-Nash: 'Maximising the time we have with patients to put across key messages.'

The completely inadequate uplift of just over 1% for GPs, fails to take into account rising practice expenses that are eating into GP funding at the same time as we struggle with record patient demand.

This lack of financial support from central government means that GPC’s recent workload guidance couldn’t be timelier.  GPs cannot rely any time soon on the core investment we desperately need to cope with spiralling workload.

Consider working with others to safely manage workload

Therefore we need to look to our own practices and our own solutions.  One such solution should be to consider working with others in order to safely manage the intense workload within ever-limited resources and start to do things differently.  Sharing risk across networks or federations of practices is one way to protect ourselves, give us much more power as small independent providers and ensure we have the financial and workforce viability we need to provide quality general practice in the future.

We should also start involving patients much more in how services are delivered locally.  For many simply continuing do the same as we always have is simply becoming unsafe and is no longer viable, both in terms of the financial cuts and personal cost to GPs.

If services are no longer to be funded, patients must be informed of the change and practices consider ceasing this activity if they feel they are no longer able to provide the service. Too often relations with patients start off in a negative context: usually to defend in an almost scared fashion cutbacks to services based on the contracting budgets many practices are facing, through no fault of their own.

This is a perfectly understandable mindset, especially as we feel desperate that we have to make these decisions, but it is important to step back and ensure that the way workload pressures are discussed are framed in the right way. Changes to services should not be sneaked out or spun; it is best to be honest and clear with patients about how and why services are being affected. GPs want to provide a properly funded high quality service as much as patients’ value having one, but it is not our fault that we are being forced to consider these changes.

Maximising the time we have with patients to put across key messages 

There are two key elements to making this happen.  The first is proactively bringing patients into the reasoning behind the decisions being made and the second is about encouraging them as individuals take control and as we do nationally, to highlight the importance of general practice and lobby for services.

On the former, GPC’s guidance contains a number of practical tips based on some outstanding work already being done by GPs. This includes producing newsletters, keeping an orderly, up to date website and maximising the short amount of time we have with patients to put across key messages about what is happening in the practice. Posters and leaflets are still an incredibly important tool – especially if you are considering or implementing changes because of workload pressures. Examples to help you do this are provided in the guidance.

The bottom line is GPs cannot cope with need let alone want.  Unless patients are enabled to look after themselves better and seek alternative advice other than the usual default position of ‘see your GP’ we will not cope with ever increasing demand.  That is why we need a national self-care strategy and tools to help patients stay healthy and ensure they know when they need to see a GP or use alternative service such as community pharmacy if more appropriate do so.

It is difficult, especially given the little spare time GPs have, to think about the patient role in the decisions GPs are having to make, not least as budget cuts are draining emotionally. But it is vital that all GPs take a pause and consider how they bring patients into the tent: after all it is a service for us all and we need to be honest with them about what is happening and what lies ahead.

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