GPs must stop unfunded work now to protect patient safety, warns GPC chair

GP practices must be willing to reject unfunded and inappropriate work to maintain safe primary care, GPC chair Dr Chaand Nagpaul has warned.

GPC chair Dr Chaand Nagpaul

Thousands of practices across the UK are providing unfunded services, and most receive requests to carry out work that should be done by hospitals on a daily basis, the GPC chair told GPonline.

Dr Nagpaul warned that practices continuing to provide services they should not be delivering at all, or services that they were not being paid to provide, risked undermining their ability to provide safe care, and urged practices immediately to follow BMA advice to halt this work.

A GPonline investigation this year showed that GP practices across England are continuing to deliver services worth millions of pounds - which should attract enhanced services funding - for free. One in three practices had dropped at least one unfunded service over the past year, but around three out of five say they provide at least one service identified by the BMA as outside the core contract without additional funding.

GP funding

The BMA has also warned that 15m GP appointments a year are lost because hospitals are dumping inappropriate work on general practice despite clauses in their contracts meant to prevent this, and has published template letters to help practices reject this work.

The GPC chair's comments came after the campaign group GP Survival published an open letter to him following a recent meeting, warning that the profession was 'being decimated' and that unfunded GP workload 'has to stop'.

The letter says that the campaign group's members believe the BMA should back a 'mass withdrawal of those enhanced services which are not appropriately funded', adding that if the BMA proposed such action it would 'give practices the security of knowing they are engaging in a union-backed campaign'.

Dr Nagpaul told GPonline that practices prepared to push back against unfunded and inappropriate work have the full support of the BMA.

GP workload

He said the union planned a renewed campaign to highlight its guidance on dropping unfunded and inappropriate work early in the new year, but told practices and LMCs there was 'nothing to stop them' using this advice now to protect general practice.

'GPs should not be providing services outside their contract that are not funded,' Dr Nagpaul warned.

He said defining nationally which services GPs should drop was difficult, because services delivered without funding in some areas were funded in other parts of England or the UK. A list of 'non-core' services that were being paid for as enhanced services in parts of England was published in the BMA's Quality first: managing workload to deliver safe patient care guidance in a bid to address this issue.

'If GPs give their time away from core duties to provide unfunded care, that is undermining their ability to provide safe care,' Dr Nagpaul said. Pointing to recent BMA polling that found eight in 10 GPs face unmanageable workload, he said: 'Lots of GPs are struggling to provide safe care - practices have to follow our advice to stick to their contract. That is the message we have been putting forward consistently. It is vital that practices do not - in trying to be helpful - do work that they should not be doing and make themselves unable to do work they should be doing.'

The BMA and others have been clear that issues including long-term underfunding, rising demand, recruitment problems and and the erosion of services around general practice are huge contributors to the soaring pressure facing the profession. But dropping unfunded work is one step practices can take to help address the situation themselves.

Dropping unfunded work and rejecting inappropriate work dumped on them by hospitals was not industrial action, Dr Nagpaul pointed out, but simply 'working to your contract'.

'Our resources are being updated on an ongoing basis - we have templates for rejecting not just unfunded enhanced services but other inappropriate work - this is union-backed and no practice has to feel it is anything else,' he said.

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