'Eventually it will have to break': LMC alert systems show general practice in distress

Growing numbers of GP practices are reporting unsustainable pressure as staff absences triggered by COVID-19 leave them struggling to cope with soaring patient demand, LMCs have warned.

Pressure gauge with broken glass
Under pressure: LMC systems show strain on GPs (Photo: Jeffrey Coolidge/Getty Images)

GPonline has learned that LMCs across the country have seen significant increases in the number of surgeries reporting red and black alerts through local warning systems, with one chief executive warning practices were in a ‘delicate state’ and teams ‘exhausted’.

Patient demand has been described as the ‘single biggest problem’ facing GP teams, but LMCs say staff absence caused by increasing COVID-19 cases is adding major pressure. Others have said staff will ‘start walking’ after the pandemic due to unsustainable pressure.

Warnings about high workloads come as the RCGP chair warned earlier this month that the profession was ‘working to its limits’, while the BMA has labelled general practice the ‘forgotten soldier’ amid rising pressure on NHS services.

General practice pressure

Some LMCs have said the true reality facing general practice could be even worse than local alert systems suggest - and said a national initiative similar to the operational pressures escalation levels (OPEL) framework used by hospitals could help the profession present more powerful data on workload to CCGs and NHS England.

Devon LMC chief executive Bob Fancy, who helped to launch the county's own GP workload alert system in 2020, told GPonline that practices near him had been reporting higher levels of distress since the last quarter of 2021, and warned that the landscape was deteriorating.

‘Since September we've been declaring the equivalent of OPEL level four, which is red across the county, numerous times - and tracking progress in our weekly reports. I have no idea how general practice manages to keep going - and it does keep going - but eventually it will have to break.

‘The key issues are the continued unauthorised transfer of work from secondary to primary care. Appalling patient expectation management nationally [is also an issue]...and sickness induced by COVID-19 is compounding that as well. All that is making practices' resilience really, really fragile...it's just horrendous.'

Retention issues

Mr Fancy said staff turnover was starting to become problematic, insisting that it could become a much bigger problem once the pandemic calmed down. He said: ‘The sense that I'm getting is that people are hanging on and hanging on because they're driven to try and help the nation in its moment of crisis.

‘But when that goes away, we are seriously concerned that people will start walking because they've done their bit, or maybe they'll retire a bit earlier than they were going to because they're absolutely exhausted and they can't see any light at the end of the tunnel.’

Cambridgeshire LMC is currently reporting an 'amber' alert level overall amid staff shortages linked to COVID-19 and sharp increase in patient activity, but significant numbers of practices are running at 'red'.

An LMC spokesperson said practice staff are working longer hours to maintain business continuity and highlighted the continued transfer of unresourced work from secondary care.

They said: ‘Our Primary Care Alert Status (PCAS) is currently showing an overall picture of amber, but with significant fluctuations of around 20% reporting red in any given week which has been the reported status for the last couple of months. There is a concern that an amber state is becoming normalised.

Unresourced work

‘There is also a concern that those practices most in need have the least time and headspace to report.’ Around 50% of practices in the area are reporting data each week, with the LMC working on ways to increase engagement.

The spokesperson added that general practice staff in the area were suffering from stress and exhaustion due to heavy workload, warning that efforts to keep up with demand were ‘not sustainable’ in the long term.

‘We are all operating in a broken system, and GP teams are human, they cannot fix the faults. We will be working with our practices this year to remind them to ‘apply their own oxygen masks first’ and how practices can safely embed sensible limits to work that fall within the spirit of the regulations.'

Nottinghamshire LMC chief executive Michael Wright told GPonline the area's own alert system, which has been running for around two years, had seen more practices reporting red alerts recently, while some were getting close to black.

Black alerts

‘There are more practices reporting a red alert saying they're getting close to unsustainable - and areas that have never previously marked themselves out as being in difficulty now say they are. A major driver is patient demand on services, that’s the single biggest issue for practices...COVID-19 absences are also a big enemy right now adding to pressures.'

Mr Wright said that he had heard from GPs in recent weeks taking a few weeks off work because of burnout. He admitted that it was currently difficult to collect accurate data on GP workload levels due to the subjective nature of reporting. He suggested a national system could improve this.

‘If, for example, we extracted data from the appointment systems and looked at how quickly appointments were used up in the morning, that would be a good way of assessing demand and pressure,’ he said.

‘If we had a national system, which could tap into systems and you could work out the quota of sessions for capitation or GP, you could have a comparator that you could use and that's what I think is missing - some kind of national way of assessing pressure.’

Professor Marshall argued last week that significant underinvestment in general practice and poor workforce planning, in addition to pandemic pressures, had left the profession overstretched. He called on the government to deliver on its promise of recruiting 6,000 extra GPs by 2024.

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