Exclusive: GP practices forced to limit services to control workload

Two thirds of GP partners and practice managers say their surgery has opted out of part of the QOF or enhanced services because of workload pressure, a GP magazine poll reveals.

Dr Richard Vautrey: practices under pressure (Photo: JH Lancy)

A total of 68% of 377 GP partners and practice managers across the UK said they were opting out of services.

GPC deputy chairman Dr Richard Vautrey said financial pressure had left practices ‘increasingly looking at their bottom line’.

Many had decided that some services were not cost-effective or clinically beneficial enough to justify the workload involved, he said.

Dementia DES concerns

A significant number of respondents cited the controversial dementia DES as a service their practice had opted out of providing. The DES offers practices £55 per additional dementia diagnosis, but has been condemned as ‘unethical’ by many GPs.

But a wide range of services were among those practices can no longer sustain.

Some respondents said they had opted out of the learning disabilities DES, could no longer provide support for nursing homes, or had stopped minor surgery.

Others said they had reduced extended hours provision, public health services or had dropped enhanced services intended to limit hospital admissions.

Dr Vautrey said: ‘GPs want to provide the best possible care within the available resources – that is the number one priority. But the key is that you provide a safe service.

Undermining quality

‘There is no point doing more and more and starting to undermine the quality of care you provide to patients – it’s not just about extra money.’

Dr Vautrey warned that practices were being forced to turn down some new work to maintain standards in other services they provide.

A GP partner in Devon who responded to the poll wrote: ‘We have rejected the dementia DES due to workload and ethical concerns. Many QOF indicators that provide low clinical value are not being prioritised.’

He said the practice had been unable to achieve payment for the patient participation group and care planning enhanced service in 2013/14 due to ‘factors outside our control’.

‘It is like going to the casino – we do most of the work but don't even get part payment,’ he added.

‘We worry that all our hard work towards this year’s admission avoidance enhanced service may end up in no payment.’

The ‘massive breakdown in trust’ caused by problems with receiving payment for enhanced services had made the practice ‘very cautious about taking on enhanced services’, he said. ‘We may instead look for other income streams such as increasing list size and non NHS work.’

A partner from Lancashire said taking on new services was not an option. 'Even if the financial benefit was worth it we do not have the capacity to take on more work. We are struggling just to get through each day.

Other practices said they felt compelled by financial pressure to deliver all possible services. 'We are over a barrel and can't afford to lose more income,' wrote one partner.

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