Exclusive: Four in five GPs say social care cuts are driving up practice workload

Four out of five GPs say that cuts to social care services have increased workload at their practice over the past 12 months, with many warning elderly patients are ending up in hospital unnecessarily.

Social care shortfall has added to GP workload (Photo: Simon Barber)
Social care shortfall has added to GP workload (Photo: Simon Barber)

GPs report increasing waits for routine social care assessments, problems securing respite care and being forced to seek hospital admission for patients who could have been kept at home with better social care and community support.

Four in five GPs also say that social care support for their patients has deteriorated over the past year and three quarters have struggled to access social care support for a patient who needed it, according to findings from a GPonline poll of 521 GPs.

The findings come after the government acknowledged pressure on social care in the spring budget earlier this year, pledging £2bn of new funding for social care over three years, starting in 2017/18.

Social care funding

GPC chair Dr Chaand Nagpaul this week cited an ongoing crisis in social care as a key factor driving soaring pressure on general practice. GP Forward View plans to boost GP funding by £2.4bn by 2020/21 were insufficient because general practice needed a rise of that magnitude immediately to maintain services, he warned, and because workload was moving into practices constantly both from hospitals and sectors such as social care.

One GP responding to the poll said social care was 'on its knees'.

Another highlighted a 'huge shortfall in social care particularly for the elderly'. She warned of seeing 'many cases of avoidable hospital admissions' for older patients 'which could have been prevented with better access to urgent social care'.

One respondent warned: 'High proportion of elderly patients in our area, many waiting weeks for routine social care assessments and hospital discharge delayed by lack of local home carers.' A similar response said: 'I have had to admit patients who would have previously been managed in the community with intermediate care or hospital at home or crisis care because there are no carers available.'

Another GP warned that there had been a 'big deterioration' in social care support available: 'It is now virtually impossible to arrange urgent respite care for patients who are struggling to cope and a danger to themselves at home and it becomes necessary to consider hospital admission for these patients, despite there being no acute medical need.'

GP workload

GPs also reported problems contacting social care services on patients' behalf, particularly out-of-hours, at short notice and busy times.

One GP respondent said: 'Very difficult to get adequate support for patients. Difficult to contact social support, especially during lunchtime and after 4pm, when most GP phone calls occur.'

Respondents also said patients had been forced to move into nursing homes because of the lack of support for them to stay at home, while others said they had been unable to access nursing home care.

GPs reported taking on additional work that was well beyond basic general practice to help their patients, and advising them to keep money aside to fund their own support care to ensure that they were able to come out quickly after a stay in hospital.

One GP said: 'We now tell our patients to start putting money aside and keep a list of local carers that they can employ themselves so they can get out of hospital sooner rather than wait for state care to be arranged.

'We also fix up potential care home beds so social services cannot stall us by agreeing a patient needs to be in a care home but it will take time to find one - I can say it will take then a few seconds as all in place. But we shouldn't be doing this - nor should we be employing practice nurses to do home visits because the community team cannot provide holistic care.'

In a statement released with the March spring budget, the government said: 'The budget takes further steps to improve the services people care most about, providing more support for health and social care.

'Building on the short-term actions taken in December 2016, the government will provide £2bn additional funding for social care to councils in England between 2017/18 and 2019/20, to help ensure people receive the social care support they need and to reduce pressure on the NHS.'

The government has also promised a green paper to set out measures to 'put the social care system on a more secure and sustainable long-term footing'.

A joint statement on health and social care by think tanks the King's Fund, the Nuffield Trust and the Health Foundation, meanwhile, in November 2016 warned that social care was in a 'critical state'.

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