Dr Farah Jameel: Best way for GPs to put patients first is to drop unfunded work

You wouldn't expect a builder to do a job on the side for free, or ask a lawyer to do some extra work without being paid for it. So why should it be any different for GPs, asks GPC executive committee member Dr Farah Jameel.

GPonline’s latest poll of GP partners found that more than two thirds are providing non-core services in their practices for which they do not receive additional funding. That is, work done without any resources.

This is completely unacceptable. General practice is under tremendous pressure as it is, without having to take on activity that is not funded. It is not in a doctor’s nature to refuse to treat patients, and this survey shows how practices are trying to meet the needs of their patients despite the lack of support from CCGs.

At a time when doctors tell us that workload in general practice is reaching unmanageable and frankly unsafe levels, it is another example of GPs’ goodwill being exploited and taken advantage of.

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By offering non-core services without appropriate funding - and therefore the additional workforce, time and resources required - GPs and practice staff are stretching themselves to the extent that they risk the quality and safety of the essential services they are contracted to provide for their registered patients.

In 2015, the BMA’s GP committee (GPC) published our 'Quality First' guidance on managing workload, which advised practices on enhanced services and how to go about turning down or ceasing unresourced work.

GP workload

But there is clearly more work to be done, which is why last month we released our GP workload strategy, which not only called for the agreement of a set of quantitative safe working limits, but also recognised the need for a cultural change within general practice from one of 'quantity overload' amid shrinking resources to one of efficient demand and workload management. Doctors must feel empowered to say no.

Without a pragmatic approach to the workload crisis, GP morale will continue to plummet, and the retention and recruitment problems afflicting general practice will only get worse. This is not about restricting GP services. It is about providing safe, quality and accessible care to patients, at a time when GPs are being prevented from doing so by excessive and inappropriate or unresourced work, which is taking them away from their prime duty of care as GPs.

Accepting unresourced shifted work risks and undermines the quality of patient care and over time risks practice viability. It is vital that we push back on inappropriate demands rather than allow them to continue unchallenged.

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