Two-thirds of GPs have felt pressured to work outside their competence

Over two thirds of GPs have felt pressured, or been expected, to work outside their competence during the past year, a poll has found.

A UK prescription with pills next to it
Prescribing is a key area where many GPs say they have been expected to practise outside of their competence (Photo: Getty Images)

The GPonline survey of 244 GPs from across the UK highlights how spiralling waiting lists for hospital treatment is piling pressure on GP practices – with GPs themselves often being expected, or asked, to carry out tasks that they do not feel trained to deal with.

The poll found that 68% of GPs felt they had been expected to work outside of their competence. All of these doctors said that a lack of options to refer patients to and long waiting lists to access services had been why they had found themselves in this position.

The vast majority (98%) also said that requests from hospitals to prescribe medicines had lead to them feeling pressured to practise outside of their competence and 76% said it was due to hospitals requesting practices undertake other management plans. Meanwhile 78% said the reason was due to some other transfer of work from hospitals that they felt was inappropriate.

Inappropriate transfer of work

The findings follow results of another poll by GPonline earlier this year when 81% of GPs said that that their practice was experiencing inappropriate transfer of work from hospitals.

GPs responding to this latest poll highlighted the 'unprecedented' workload that general practice was facing. Alongside work transfer from hospitals, many GPs said a shortage of staff had also left them feeling out of their depth at work.

One GP responding to the poll said that they had been left to manage acutely unwell patients in the community who they felt should have been admitted, but this was not possible because the because the hospital was too busy. Another cited an example of being expected to undertake genetic screening and counselling for a patient when this should have been done by a specialist team.

Problems with rejected referrals, and the use of advice and guidance services where hospitals provide advice to GPs on how to manage patients, also meant GPs were having to manage patients in primary care who they felt should be under the care of a specialist, GPs said.

Rejected referrals

One GP responding to the poll explained: 'Advice and guidance is being used to ensure primary care ends up doing the work usually undertaken by secondary care, eg requesting bloods we cannot interpret, repeatedly monitoring patients without safe recall systems in place - with no additional funding.

'Secondary care is still using the telephone outpatient clinic model, without systems in place to manage patients appropriately such as prescribing or examining, so asking GPs to do these things on their behalf. Virtual wards are also adding to workload as hospitals are not completing their own actions and asking for further GP review/input when patients should be under care in secondary care. More referrals are being rejected than ever before - inappropriately.'

Another added: 'Too many speciality issues are passed on to primary care to deal with. It is not possible for primary care to keeps abreast of every single secondary care topic, especially with multiple updated guidelines, new medications in every field. '

One GP responding to the poll said: 'It is like working in treacle. Secondary care is so congested that they can't cope. They pass their work onto primary care unaware that they are breaching their own contract. GPs are under so much pressure and don't have the resources. Patients are stuck in the middle and think GPs are to blame.'

Another added: 'In 12 years of general practice I have never seen such unprecedented workload demands. It is way more than during the height of the pandemic. There needs to be a shift in thinking as to how to cope with this as it is not sustainable in its current format.'

NHS waiting lists

Earlier this year LMCs called on the government to provide practices with additional funding to help them cope with the extra work they are dealing with as a result of growing hospital waiting lists. Delegates attending the UK LMCs conference said it was 'unacceptable' that none of the government funding for the NHS's elective recovery plan in England had been earmarked for use in primary care, despite the fact GP surgeries are dealing with increased workload as a result of the backlog.

Latest NHS figures for England that cover the period until April 2022 show there are a record 6.48m people on the NHS waiting list - a rise of 124,013 on the previous month.

Health and social care secretary Sajid Javid has previously warned that the waiting list will continue to rise for the next two years. In an interview with The Telegraph last summer he also suggested the list could hit 13m people.

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