GP practices braced for spike in workload as winter adds to NHS pressure

More than three quarters of GPs believe their practice will struggle this winter because pressure on hospitals will leave patients 'bouncing in and out' of surgeries and driving up GP workload.

GPs under pressure (Photo: BSIP/Getty Images)

Of 141 GP partners who took part in a GPonline opinion poll, 81% predicted that their practice would struggle this winter, with just 12% feeling their surgery would be able to cope and the rest unsure. Across all 480 GPs who responded to the poll, 76% said their practice would struggle.

Problems referring patients to hospital and rushed discharges at A&E departments were among key concerns highlighted by GP partners as likely to drive up pressure on practices.

Practices already face extra workload 'dumped' on them by hospitals, with LMCs warning last week that acute trusts were ignoring contract requirements not to transfer work inappropriately to primary care and demanding fines when rules are breached.

NHS waiting times

But GPs fear measures adopted by hospitals struggling to turn around record waiting times - with more people waiting over four hours in A&E than at any time since 2004, soaring numbers waiting over 18 weeks for hospital treatment and cancer treatment targets missed - will drive up GP workload further still.

GPs warned that pressure for hospitals operating at maximum capacity to discharge patients quickly would add to strain on primary care, with patients increasingly likely to ‘bounce in and out’ of practices. Staff shortages and rising patient demand meant general practice would struggle to absorb pressure spilling over from struggling hospitals, GPs added.

BMA GP committee chair Dr Richard Vautrey told GPonline: 'All parts of the NHS are currently facing intense year-round pressures, and GPs feel the impact of this every day as the first point of contact for most patients seeking care. Many practices are facing a tough winter ahead and are finding it difficult to recruit the staff needed to cope with increased demand.

'It is worrying that many GPs feel patients are being discharged from hospital too early, and that this is having a knock-on impact in primary and community care. Too often patients lack the social care needed to enable them to be properly supported at home after hospital discharge. This reflects the fact that the system as a whole is simply not sufficiently resourced to cope with the level of demand we’re currently seeing.

Hospital discharge

'That’s why we need urgent investment put into our health service and social care to ensure that it not only survives the upcoming winter, but is also sustainable in the long-term, both for hardworking staff and the patients we serve.'

One GP responding to the survey said: ‘With hospital services crumbling, demand for [GP services] is going through the roof. We cannot afford more locum cover, even where that is available. Patients will have to wait to be seen and the consequences of that may be severe,’ one GP said.

Another GP partner said: ‘My concerns are that secondary care have a "discharge ASAP" policy whereby they dump their workload on primary care. As steps to prevent admissions, we have targeted flu clinics, agreed and inspected care plans.'

Partners also warned they had struggled to hire temporary staff. ‘There is an extremely short supply of locum cover and local practices are closing, increasing patient numbers - we cannot keep up with demand,’ one respondent said.

Another said: 'Not enough staff to cope - and not enough staff waiting in the wings to help and there just aren't enough employees for the volume of patients.'

Winter pressure

Earlier this month, the BMA warned that trusts and GP practices were ‘almost certain to ensure the most pressurised winter on record’ and demanded extra funding as well as an end to pension taxes that had severely damaged the medical workforce.

GPonline revealed this week that more than 90% of GPs think the NHS as a whole will struggle to cope this winter and that patients will be put at risk.

NHS England (NHSE) has said measures to reduce pressure on the NHS this winter include increasing public flu vaccination levels, education campaigns to help people stay well and choose the right services, and increasing access to NHS 111 service.

It added it was providing targeted support for local services through access to senior clinicians who would help manage any emerging issues over the winter period.

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