GP leaders at the 2021 UK LMCs conference warned that practices were being forced to fend off a constant stream of letters and demands from secondary care - asking practices to prescribe medicine, re-refer, carry out tests and other work that is clearly within hospital contracts.
Senior GPs warned that practices were already under intense pressure, leading the COVID-19 vaccination campaign on top of an expanded flu campaign, with a GP workforce in decline and demand surging after more than a year of the pandemic.
Delegates at the conference voted overwhelmingly to reject a motion suggesting that practices should take on an increasing amount of work from secondary care if it was clinically appropriate and properly resourced - and warned that preventing hospitals dumping work on primary care was not simply a matter of 'learning to say no'.
GP workload
GPC executive team member Dr Farah Jameel told the conference that letters from hospital 'commanding us to do endless tasks' and a persistent failure on the part of NHS commissioners to prevent this unreasonable transfer of work once and for all was 'infuriating'.
She told the conference that GPs were looking after around 60m patients, delivering 28.5m appointments in March 2021 in England alone, along with more than 300,000 referrals and 8m prescriptions a week - in a year when the profession has delivered a record flu campaign and the bulk of around 53m COVID-19 jabs.
'We must not lose sight of how general practice has been the footsoldier of this programme,' she added. 'The planners, the holding bay, agony aunt, telephone booking service, transcribers, record locators, corrector service - where there has been a problem we have been the answer.'
Dr Asif Faizy told the conference that 'advice and guidance' processes rolled out during the pandemic -intended to connect GPs and hospital clinicians and limit referrals and admissions - had led to GPs being pushed to 'work way beyond their skills and competencies' as they carried out tasks that should be completed in hospital.
Hospital admissions
'Colleagues report that the advice and guidance process expects us to work as a cardiologist, rheumatologist, paediatrician and neurologist - all in a single session,' Dr Faizy said. He said the success of the schemes was measured on numbers of admissions and referrals avoided - while 'their impact on GP workload and patient care is not measured at all'.
Nottinghamshire LMC chair Dr Greg Place said he had no problem carrying out even quite heavy workload as long as it was appropriate. But he said: 'We really do have a bit of a problem with secondary care referring us their work.'
He listed 'sick notes they should give on discharge, naff A&E letters with incorrect diagnoses, medication on discharge just not being done' and said GPs were constantly forced to push back and refuse to follow up on results for hospital colleagues, or refer on to another service on their behalf.
'This is all your job. The hospital contract changed a while ago, it is very clear. This is the kind of work that is grinding us down. I don’t want to start doing hospitals’ work for them. If they did it our life would be so much easier.'
GMC threat
Dr Place said that when he had raised the issue with consultants, in one case he had been threatened with referral to the GMC - and called for the BMA's GP committee to put more pressure on hospitals and hospital doctors to stick to their contracts.
Dr Rachel Ali also told the conference that workload was simply 'overwhelming' in general practice at the moment, with 10-hour days regularly turning into 13-hour days in part because of work transferred from secondary care that was 'completely unacceptable and unsustainable'.
BMA consultants committee member Dr Simon Walsh told the conference that hospital colleagues shared many of the concerns raised by GPs - and that they did not want to pass on test follow-ups and chasing results, but were 'frustrated by systems' they were told to work with.
He said the COVID-19 pandemic had brought the NHS 'as close to a failure to be able to provide services to patients as we could get' - and acknowledged that wherever work is taking place in the NHS 'it must be resourced adequately'.
'If you are being asked to do work you do not have the resource to do of course that is not reasonable,' he said - calling for a 'wholesale review' and work across primary and secondary care to find solutions.
Northern Ireland GPC member Dr David Ross said the imbalance between capacity and demand in general practice had never been in such sharp focus as it was now in his 35 years in general practice - and backed calls for work with consultants to resolve problems with workload transfer.
