Hospitals should be fined for dumping workload on general practice, say LMCs

Hospitals should be fined for inappropriate transfers of work to primary care and the proceeds used to compensate GP practices, LMCs have said.

Delegates at the 2020 England conference of LMCs backed a motion demanding 'financial sanctions' against providers that fail to limit the unfunded transfer of work to primary care - warning that the COVID-19 pandemic has seen a major surge in tasks dumped on GPs by hospitals.

LMCs backed a call for hospital doctors to undergo annual training on their 'duties and responsibilities under the NHS Standard Contract', for hospitals to follow up investigations initiated in secondary care themselves.

They also warned that with more than 100,000 patients waiting more than a year for hospital treatment, GPs must not be held responsible if a patient's 'clinical medical condition deteriorates whilst on unacceptably long waiting lists'.

COVID-19 pressure

Hillingdon LMC chair Dr Mitch Garsin told the conference: 'We are all deeply aware of the extreme pressure on colleagues in hospital over the past nine months. Our gratitude for their dedication knows no bounds.'

General practice has also seen an 'explosion of workload', he warned - with demand suppressed during the first lockdown piling pressure on top of an existing workforce crisis exacerbated by frequent staff self-isolation, an extended flu campaign and now a COVID-19 vaccination campaign.

'It is no surprise general practice is struggling to cope and in real danger of collapse,' Dr Garsin said.

'It is with real dismay that we have also had to manage a tsunami of work that has been dumped on us by a secondary care system that has followed the age-old maxim that "if we are too busy to do it or don't know what to do with it, send it to the GP and they can sort it out".

Workload transfer

'We've had to re-triage secondary care referrals not dealt with at the start of the pandemic when hospitals should have held on to them and dealt with them appropriately. Investigations sent back to general practice with a note simply saying "can't do this at the moment, send it back when it's all over".

'Letters from consultants and juniors asking us to follow up on hospital-initiated investigations or to prescribe drugs we have no experience in managing or asking us to refer on to their colleagues or telling us to order an investigation we have no access to. I could go on.'

He said the problem of workload dumping onto primary care pre-dated the pandemic, but had been exacerbated by it.

Dr Garsin said the BMA GP committee must send the message that primary care was 'not a dumping ground' - and that if work did need to be transferred to general practice during the pandemic this must be 'defined and funded.

General practice at risk

He added: 'General practice is the bedrock of the NHS. If we do not reduce the ever-increasing load on those foundations we risk the whole edifice crumbling to the ground.'

Dr Zishan Syed from Kent LMC hit out at private sector hospitals also dumping work on NHS primary care - condemning 'parasitic abuse' of the system by doctors who had seen patients in hospital privately then referring them back for prescribing or onward referral on the NHS.

Cambridgeshire LMC chief executive Dr Katie Bramall-Stainer told the conference a recent workload survey by the LMC found practices had taken on 8.6 hours of additional work per week from hospitals dumping work onto primary care.

'There is no system consideration of the impact of the workload, of the implications or the resources required for the practices to carry out the work,' she warned. Dr Bramall-Stainer said inappropriate workload transfer was unsafe and unsustainable and general practice must push back.

LMCs voted heavily in favour of the motion below in all parts - with section 'iv' taken as a reference.

Read the motion in full:

That conference is concerned about the unfunded transfer of workload and responsibility from secondary care to GP during COVID-19, and calls on GPC England to:

  • (i) ensure all secondary care clinicians undergo an annual educational activity covering their duties and responsibilities under the NHS Standard Contract
  • (ii) urgently negotiate that NHSEI mandates that all investigations initiated in secondary care are followed up in secondary care
  • (iii) ensure that GPs are not held responsible if their patient’s clinical medical condition deteriorates whilst on unacceptably long waiting lists
  • (iv) insist that NHSEI formally engage with CCGs to provide clear guidance on how to define unacceptable workload shifts
  • (v) agree financial sanctions against providers who do not reduce this transfer, with resulting funds being paid directly to affected practices.

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