BMA guidance tells GPs how to refuse unfunded work

GPs should refuse inappropriately referred and unfunded workload, new BMA guidance for reducing workload pressures has said.

Dr Chaand Nagpaul: GPs under pressure (Photo: JH Lancy)
Dr Chaand Nagpaul: GPs under pressure (Photo: JH Lancy)

The GPC-produced handbook provides practical advice on coping with the escalating workload burden.

The guidance, Managing workload to deliver safe patient care, gives guidance for working within manageable limits to deliver safe quality care. 

The GPC called on CCGs and NHS managers to stop inappropriate demands on practices. Practices, the guidance says, should use their membership to require CCGs to develop policies and specifications with providers that make the scope of service provision clear.

Pressure on GPs

The GPC is writing to CCGs asking them to make GP service pressure a standing item on all future board meetings.

Meanwhile NHS England has commissioned the NHS Alliance and the Primary Care Foundation to look at how to reduce workload in general practice, the GPC said. It has also commissioned a project as part of the prime minister’s Challenge Fund to identify and reduce unnecessary GP appointments, especially those generated inappropriately from other parts of the system.

GPC chairman Dr Chaand Nagpaul said the guidance aimed to support practices to provide safe and quality care to patients at a time of intense pressure.

‘GP services are under unprecedented workload pressure,' he said. ‘The demand on GP practices has far outstripped capacity. This is having a direct effect on patient services.’

Practical advice

‘The guidance gives practical advice on how GPs can focus on providing essential services to their patients and challenge some of the inappropriate and unsustainable demand on practices. This includes advice on how practices can prioritise GPs’ role as clinicians, with a primary duty of care for their patients.’

The document highlights inappropriate workload demand from secondary, community and social care as wasting GP appointment time. ‘In the interests of patient care, practices should not carry out work that has been inappropriately referred,' it says.

Practices are advised to contact the source of the inappropriate referral and require local commissioners address the problem.

A template is provided for practices asking commissioners to re-assess service specifications for parts of the health service responsible for transferring work into general practice that should have been carried out elsewhere.

The guidance provides a list of enhanced services and reminds practices these are entirely at practices’ discretion. Practices are advised to decline work shifted from secondary or community care which is not funded by an enhanced service or similar mechanism.

PMS advice

PMS practices are advised to assess which additional services are no longer being funded after local reviews. ‘If the CCG or area team decides not to commission (and hence resource) the service, then the practice is entitled to give notice to cease the service.’

The guidance advises practice on non-NHS work, empowering patients in self care, and new ways of working such as using online services, and skill mix.

On list management, GPs are reminded that a practice has the right ‘not to register new patients, provided it has "reasonable and nondiscriminatory grounds for doing so", (such as protecting the quality of patient services.) In such cases, the regulations allow practice to refuse to register new patients’.

The GPC is set to issue further guidance on collaborations and networks, which it said have the potential to reduce workload and bureaucratic burden.

Practices are advised to discuss the new guidance as a team, and to keep patients informed of any changes to services. ‘The overriding message to patients must be that any changes are in order for the practice to provide quality and safe care to patients,' it says.

Dr Nagpaul said the guidance was only part of the solution. ‘Fundamentally, the government must address the deep financial and capacity problems at the root of the crisis in general practice. These long term problems need to be addressed by all political parties as we head towards this year’s general election.’

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