GPs face unfair burden from 'layers of regulation', government admits

A government report on NHS bureaucracy admits GPs face a 'particularly high' legislative burden and promises changes by the end of 2020.

Bureaucracy concerns (Photo: Gareth Salisbury/EyeEm/Getty Images)
Bureaucracy concerns (Photo: Gareth Salisbury/EyeEm/Getty Images)

In a speech at an NHS Confederation event as the report was launched, health and social care secretary Matt Hancock promised a 'complete review of GP bureaucracy' - as part of a process launched in July.

The report, titled 'Busting bureaucracy', offers limited detail on changes that will come from the review, listing only 'alternative arrangements for issuing fit notes' and plans to scrap a requirement for cremation forms as part of changes to the statutory medical examiner system.

However, it promises 'solutions that emerge' from the GP bureaucracy review will 'begin to be made by the end of the year' - promising 'wide-reaching positive impacts' will come from 'reducing the bureaucratic burden on those who work in general practice, to have time released to care for patients and to continue to improve services'.

GP bureaucracy

Currently, the report admits, 'legislative burdens on GPs are particularly high, both from DHSC and other government departments, as layers of regulations continue to be added while few are removed'. It adds: 'Most of the weight of this regulatory burden falls on GPs despite regulations often referring to broader groups of healthcare professionals. Improved guidance and support from other professions can help to mitigate this burden.'

The 'Busting bureaucracy' report highlights wider NHS measures that should reduce pressure on GPs, including a slimmed-down revalidation process launched last month by the GMC - which it says has reduced preparation time required for appraisal to 'about 30 minutes, compared to 3-5 hours previously'.

The report also said the government would 'work with the GMC to simplify the international registration process', promising legislative reforms to reduce the current requirement of 'up to 1,000 pages of evidence to support an application to join the UK register'.

The GMC will be granted powers to ditch a 'one size fits all' approach in favour of a variety of registration routes that will make the process more 'adaptable to an individual’s knowledge, experience and skills'.

Workload pressure

The report also highlights the potential of digital improvements around remote monitoring and prescribing to take pressure off of doctors.

Promises of a reduction in bureaucracy for GPs come at a time when a recent LMC report warned that GPs at an average practice are currently working 50 hours a week more than this time last year.

Demand for GP services has spiked following a dip at the start of the first wave of the pandemic. GPs are now carrying out more consultations in total than before the pandemic began, alongside an expanded flu campaign and with a COVID-19 vaccine campaign to come - and doctors have warned that the switch to total triage has increased pressure as phone consultations can take longer and leave doctors carrying increased clinical risk.

Both the BMA and RCGP have called for a reduction in bureaucracy to come out of changes adopted during the COVID-19 pandemic.

COVID-19 pandemic

Dr Steve Mowle, RCGP honorary treasurer, said: 'Throughout this COVID pandemic, GPs and our teams have shown that we can provide safe and high-quality care without so much bureaucracy. As such, a permanent reduction in red tape and arduous regulation, and more trust in the profession - to give GPs the time they need to care for patients - is something the college has been calling for, for some time.

'While we acknowledge that overall regulation plays an important role within general practice, the pandemic has provided us with an evidence base to support its reduction and this must not be ignored.

'We still have a long way to go and GPs have a lot of work to get done - such as the delivery of the COVID vaccination programme - before things return to "normal" but looking to the future, we must learn from the COVID pandemic rather than simply returning to the way things used to be. We need governments to trust GPs to do our job well, and safely, and if they do, the ultimate beneficiaries will be our patients.'

In a foreword to the report, Mr Hancock wrote that 'excess bureaucracy reduces the time that staff have for care and hinders staff and leaders from deciding how to manage risk, being creative, innovating to fix problems, empowering others and being flexible'.

He added: 'The COVID-19 pandemic has shown us that streamlining bureaucratic processes can release time for our workforce to prioritise care.'

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