LMC Conference 2016: GPs demand daily workload cap to guarantee safety

The GPC must work with the RCGP and others to establish a limit for what is safe and sustainable for GPs to perform within a day, the LMCs conference has heard.

Dr Heather Kinsella: workload warning
Dr Heather Kinsella: workload warning

Dr Heather Kinsella from Derbyshire LMC suggested the move during a debate on workload in general practice. She said that the profession was ‘perilously close’ to reaching the limit of what it can cope with.

‘We can no longer stretch ourselves to be all things for all people at all times,’ she said. ‘I believe the GMS contract is no longer fit for purpose.’

Dr Mary McCartney from Shropshire LMC said that she had looked into workload in other countries and those countries that say general practice is sustainable ‘all have less than 25 patient contacts in a day'.

‘No other profession has this workload of 40-50 patients a day,’ she argued. ‘We should stop doing this for the patients’ clinical safety and our own sanity.’

A poll of GPs by GPonline yesterday revealed that two-thirds of the profession believe that the number of consultations they provide within a day should be capped at 30 or less.

Dr Rachel Ali from Devon LMC told the conference that there was an ‘urgent need’ for more research into ‘decision fatigue’.

‘I know I would much rather be one of my first five patient contacts of the day rather than my last five,’ she said. ‘But what I don’t know is whether I want to be the 20th, 30th, 40th or 50th and where that cut off ought to be.

‘We urgently need research into decision fatigue and how this affects all of us and where we can safely draw the line to protect ourselves and our patients from making poor quality decisions.’

List closures

Practices should also be able to close their lists as and when required in order to control workload, the conference heard.

Dr Mike Ingram from Hertfordshire LMC said: ‘Failure to control the gates and control capacity puts people at danger. The facility for us to be able to close lists is a vital tool for the safety of everyone in the practice. It protects the staff and the doctor and the patients. We must have the right to close our list whenever we think it is the best interest of our staff and patients.’

Dr Mark Semmens from Wales added: ‘As independent providers we should be able to say enough is enough, close up shop, manage our lists safely and self-declare capacity.’

Several delegates stressed the need for practices to stop doing work for which they were not paid. There were further calls for the GPC to negotiate separate contractual arrangements for providing services to care home patients, a move that was voted for at the special LMCs’ conference earlier this year.

Dr Peter Melluish from Devon LMC said this was needed to ensure the additional work involved was properly funded. Dr Stefan Kuetter from Buckinghamshire LMC said GP services for care homes needed further investment which should be shared between the NHS and care home providers.

Locality hubs

The GPC came in for criticism from several delegates for its plan for ‘locality hubs’, which it set out in its Urgent Prescription for General Practice. These hubs would be available for practices to refer urgent patients to when they have reached the capacity for safe care on any given day.

Dr Anne Jeffreys from East Yorkshire said the hubs would be ‘very costly and for a small number of patients’. She argued it would be better to ‘put more funding into existing practices and let GPs provide a good local service for their own patients.’

Dr Laurence Kemp from Cambridgeshire LMC questioned why the GPC was keen to set up a parallel system running alongside general practice. He said resources would be pumped into the new system while traditional practices were allowed to ‘wither on the vine’ and practices could eventually be swallowed by the hub.

However Dr Brian Balmer from the GPC said the idea behind the hubs was not to ‘pump up demand’, but to support existing practices.

‘Hubs are not a separate bureaucracy on top and will not be funded by taking money from practices,’ he said. ‘If its number one purpose is to benefit current practices it will benefit the whole system. If we want to increase the multidsiciplinary team the only way to do this is across a locality with patients of 30,000 plus and [hubs can help facilitate this].’

Full coverage: LMC conference 2016

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