GPs demand funding to cope with extra work caused by hospital backlogs

GP leaders have demanded practices receive additional funding to help them cope with the extra work they are dealing with as a result of growing hospital waiting lists.

LMC conference delegates voting using cards

Delegates attending the UK LMCs conference in York on Tuesday overwhelmingly backed the motion, with GPs saying it was 'unacceptable' that none of the government funding for the NHS's elective recovery plan in England had been earmarked for use in primary care.

Proposing the motion, Dr Lucy Clement from Leeds LMC cited the example of a patient on her list who is still waiting for an operation two years after being referred to the surgeon. 'Rarely a week goes by without some form of contact from the patient or the district nurses who are seeing her three times a week. They want to know what more can I do to help her with her impacting symptoms and emotional distress,' Dr Clement said.

LMC representatives also said government attempts to reduce waiting lists had been 'wholly inadequate' and warned that widespread rejection of primary care referrals by secondary care risked causing patient harm and could lead to 'significant missed diagnoses'.

Backlog of care

They also backed part of the motion calling for hospitals to appoint named, accountable individuals who would be responsible for informing practices if any GP referrals were refused.

Dr Clement said that GPs were 'trying their best' to refer responsibly, but warned that referrals rejected by secondary care had increased by two thirds.

She said: 'Those referrals that are accepted are waiting far longer, with the number of patients waiting over a year 186 times higher than previously. Even patients with suspected cancer are waiting too long, with a 93% target for patients to be seen within two weeks not being met since May 2020.

'The government's current initiatives to reduce waiting times have been wholly inadequate. And it is unacceptable that none of the elective recovery funding from the government and funded by the increase in national insurance is being used in general practice.'

She also warned that the roll out of 'advice and guidance' services, where GPs are encouraged to seek the advice of a specialist before referring, was leading to a surge in workload for practices that would previously have been carried out in secondary care.

Rejected referrals

'In my practice, we are seeing more and more of our carefully considered referrals being turned into advice and guidance with a long array of requested tests and suggested medical management plans to complete ourselves, more often than not requiring referral anyway further down the line,' Dr Clement told the conference.

'The England NHS recovery plan includes an assumption that there will be more use of advice and guidance but this brings a huge additional workload for GPs and their practice staff, which needs to be properly funded.'

However some delegates warned that increased funding for general practice could imply that GPs were able to take on work that should be happening in hospitals.

Dr Sarah Westerbeek from Kent LMC said: 'The truth is that when I refer my patients on to a specialist is because I need the team to provide additional expertise and interventions beyond what I can. So I believe that instead we should be focusing on pushing on finding ways to unclog the front end of the system so that patients can start to move through again. That's what's needed.'

The latest figures for England show there are currently 6.18m people waiting for treatment in hospitals. Dr Paul Evans from Gateshead and Tyneside LMCs told the conference that the backlog of care was clearly causing harm to patients.

Waiting times

He said he had seen patients with cataracts that had gone untreated for over 18 months, leading their condition to deteriorate and resulting in a series of falls. He also highlighted patients referred as a two-week-wait who had not been seen for over two months and were then found to have cancer.

Responding to the debate GPC England deputy chair Dr Kieran Shamrock said: 'Recovery cannot happen without general practice and general practice cannot support recovery without the resources that it needs.'

A GPonline poll earlier this year found half of GPs said patients at their practice had come to harm because of barriers to referrals into hospital during the pandemic.

Meanwhile a report by the National Audit Office in December 2021 warned that soaring waiting lists for hospital treatment were also dding pressure onto general practice, highlighting that this trend pre-dated the pandemic.

That report said that GPs have to offer additional support to patients experiencing long waits, such as managing pain and other symptoms, as well as dealing with mental health issues, including anxiety and depression, arising as a direct result of the delays.

The motion in full

The conference overwhelmingly backed all parts of the motion

That conference is seriously concerned by the impact of waiting times for secondary care NHS treatment, both on patients who are waiting unacceptably long times for appointments and on practice workload, and:

(i) believes current government initiatives to reduce waiting times have been wholly inadequate

(ii) demands that governments provide additional funding for practices to support the additional workload they are dealing with

(iii) calls on the four governments to provide clear plans for reducing lengthy waiting times so that appropriate care can be provided at the right time

(iv) believes that the widespread rejection of primary care referrals by secondary care could lead to patient harm and significant missed diagnoses

(v) insists that if a referral from general practice is declined for whatever reason, then this should be communicated by a named, accountable individual.

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