GPs are cracking down on non-core services as workload and funding pressures reach intolerable levels, the GPonline poll reveals. The finding suggests that practices are beginning to heed BMA advice that they should consider dropping unfunded work to ease pressure.
Scrapping unfunded work looks set to accelerate, with 50% of respondents stating that their practice will consider dropping services in the next 12 months and only 17% ruling this out altogether.
GPs revealed that unbearable workload pressures – exacerbated by long-term workforce vacancies – were pushing them towards dropping services.
But thousands of practices across the UK are still providing non-core services that patients rely on for no extra remuneration, the poll of almost 500 GPs shows.
Three in five (59%) reported that their practice currently provides some non-core services unfunded, amounting to millions of pounds of services for free.
The majority of GPs said their practice provided ECG recording, spirometry and post-operation suture removal for no additional payment. Just 15% of practices said they did not provide any non-core services for free.
Unfunded GP services
The poll follows a similar GPonline survey a year ago, which revealed that up to 70% of practices were providing non-core services for free.
The two surveys asked whether GPs were providing, but not being paid for, any of 33 enhanced services identified last year by the GPC in its Quality First report as voluntary and non-essential.
Responses reveal that many GPs were not aware they were providing these services above and beyond their contracts. ‘I did not realise that a lot of these services could attract additional funding,’ admitted one.
In an impassioned speech at the emergency special LMCs contract earlier this year, GPC chairman Dr Chaand Nagpaul called for ‘a shift in mind-set’ for practices to start dropping work – particularly if unfunded – to better deal with unmanageable workloads.
‘Inappropriate, unfunded and excessive workload has to stop in the name of patient safety,’ he warned.
‘No patient should suffer from a GP not being there for them because the GP is diverted doing work outside their contract. We therefore need a shift in mind-set where we must cut our cloth according to the resources we’re given to safeguard our own and out patients’ health.
‘We must learn to say "no" to that which takes us away from doing our core job, in order to say "yes" to providing safe quality care for our patients.’
But the poll shows that many GPs find this difficult to do, continuing to provide services at their own expense. ‘How could we stop [delivering these services],’ asked one respondent. ‘Who else will do it?’
‘We generally do it for the love, not the money,' said another, while one said their practice was attempting to ‘just take it on the chin as part of core services’.
Another said their practice had managed to hold on so far. ‘But as time goes on,’ they added, ‘and we lose more partners to early retirement or to other practices with a lighter workload, we will have to contemplate how we will cope.’
Others have started to take a firmer stance: ‘We have decided not to provide any unfunded work, as we do not feel appreciated for that we already do.’
GPC deputy chairman Dr Richard Vautrey said: ‘Practices are increasingly looking at the bottom line and seeing what it actually costs them to do additional services – and often when they look at that very carefully, they find it will cost them more than they’re going to get back in terms of income from that service.
GPs 'should not feel guilty'
‘But they're also looking at the impact of doing those services on the rest of their core business. When practices are really struggling to maintain the basic service to their patients, that’s what they have to focus on, rather than any additional services that may not be essential.
‘GPs and practices should not feel guilty about dropping activities if they're not resourced properly. In many ways, they almost have a duty to do so if it’s undermining the quality of service they're providing to their patients.
‘If practices really want to resolve the funding issues within the community, then they do need to be brave enough to say "no" and ultimately, if enough practices do that, then the CCG or other commissioners will have to find the resource to make that service viable if that is what they want to choose to do in the future.’