One in three GPs have dropped unfunded services in the past year

Some GPs are hitting back at heavy workload affecting the profession by dropping non-core services that they are not being paid to provide, GPonline can reveal.

Some GPs are saying 'no' to unfunded work (Photo: iStock)
Some GPs are saying 'no' to unfunded work (Photo: iStock)

Although seven out of 10 GP partners said their practice delivers some services outside the core GMS contract for no extra funding, some are pushing back by dropping services.

Almost one in three GP partners - 30% - said their practice had stopped delivering at least one unfunded service within the past year.

Many practices could go further over the coming year - with 59% of partners saying they will consider dropping more unfunded work in the next 12 months.

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Services mentioned frequently by GPs among work they had decided to stop within the past year included ear syringing, cryotherapy, minor surgery, smoking cessation and travel vaccinations.

Some of the 255 GP partners who responded to the survey said they had been forced to stop or pare back important services that had been developed at their practices - that were valued by patients - because of the lack of funding to maintain them.

Partners were often angry because of the sense that general practice is seen as a 'dumping ground' that will absorb work jettisoned by other parts of the health service. One GP said: 'It is not just patients who regard general practice as free at the point of abuse, it is NHS managers and hospital consultants who have the same attitude. Can't be arsed to do something, send it to general practice.'

Services stopped

GPs said rising workload and a shortage of funding had forced them to take tough decisions to stop providing services. One respondent said: 'We have been squeezed so tight we can't afford to continue doing unfunded work that is not recognised.'

One respondent said: 'Stopped an excellent diabetic clinic for patients on insulin/requiring insulin starts. Reduced education offered to diabetics, now diabetic patients only reviewed once a year and done by a practice nurse - previously a GPSI ran the diabetic service for type 1 diabetics and type 2 patients requiring insulin.'

BMA leaders have encouraged GPs to drop unfunded work, warning that CCGs that 'exploit practices' goodwill' by expecting them to maintain services that are not paid for, risk putting patients and the profession at risk.

The BMA has drawn up a list of services that are outside core work covered by basic GMS contract funding - which should attract additional money if practices provide them. A total of 88 services are on the list, which is growing as the union gathers examples of enhanced services that practices are being paid to provide in parts of England.

The findings come after the BMA published workload guidance to help practices limit pressure on GPs - with advice from the union suggesting that a safe limit could be as low as 25 routine consultations per GP per day. Many GPs currently provide far more than this - while the BMA says that general practice is underfunded by more than £3bn, in addition to problems caused by a workforce shortage and the growing, ageing population.

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