The BMA has published ‘safe-working guidance’ for GP practices which it said would lead to a ‘fall’ in appointment availability and some patients having to be seen elsewhere.
The advice includes ‘ceasing’ ‘all non-contractual work’ and ‘diverting’ resources ‘to core services’.
The BMA’s GP Committee for England said this comes as ‘GPs and practices are seeing nearly half the of the country’s population every month’ and they now ‘need to control the speed of their hamster wheel’.
Advice reiterates guidance to move to 15-minute appointments to ‘help reduce the need for multiple repeat appointments and support continuity of care’; limiting patient contacts per GP to 25 per day; and setting up patient ‘waiting lists’.
The GPCE’s ‘main outline’ for how to manage appointments states:
- Appointments 15 minutes in length
- No more than 3 hours out of each 4 hour 10 min session should be spent consulting
- Applies to all GPs (partner, salaried, locum), and clinical staff undertaking consultations
- Signpost to other services in the system once capacity reached
- Safety net plans for urgent cases – signposting/urgent slots/duty doctor
- Routine appointments may need a wait list if capacity reached
- Communicate systems to patients, outlining steps should condition change with clear safety netting
- Use whole practice team.
- Review appointment setup if regularly running over
The guide also advises practices to improve the recording of their workload, including counting ‘even brief and informal types of contact’ towards its number of patient contacts reported to NHS England.
The GPCE said: ‘By introducing the BMA’s Safeworking Guidance: a handbook for General Practice, in the majority of practices the number of offered appointments each day will fall. This means some patients with non-urgent problems may have to wait longer, but the priority is to ensure those patients that are seen receive safe care within your limited capacity to provide this.
‘There will be times when patients will need to be directed to more appropriate alternative services than are available at the practice. Overall, the steps we outline will allow your practice to devote its resources to those patients it is best placed to help.’
According to GPCE, the guide is ‘designed to help GP practices make decisions that will allow them to prioritise their limited capacity to deliver safe, high-quality care’ but decisions on how to implement the advice ‘will need to be individualised to the needs of your patients and practice’.
Outlining how workload has risen while funding remained limited, BMA said the ‘present crisis’ is now ‘so severe that GPC England strongly recommends practices take urgent action to preserve their ability to deliver safe, high quality patient care and to protect the wellbeing of their practice teams’.
‘GPC England encourages all LMCs to promote and support practices in their implementation of the BMA Safe Working Guidance,’ it added.
LMCs should consider setting up OPEL black alert systems, the guide added; while GPs should stop participating in advice and guidance as per the options outlined in the menu for collective actions.
Collective action began on 1 August after GP partners voted in favour of taking action in protest against contractual terms and funding.
After the BMA announced the results of its non-statutory ballot, which saw 98.3% of GP partners voting in favour of taking collective action, NHS England said that ICBs should make sure that practices are continuing to meet contractual requirements during the action.
Pulse exclusively revealed that almost half of England’s GP practices are already taking some form of collective action, with the most popular option being limiting the number of daily patient contacts.
The BMA’s GP safe working checklist
- Assessing patient and practice needs, in discussion with your team and PPG
- Mapping workload
- Mapping resource streams and staffing
- Practice discussion
- Workload prioritisation – core and non-core – and where necessary using workload control template letters
- Engaging stakeholders: PPG, councillors, Healthwatch, commissioners
- Communication – eg letters, Accurx
- Establishing triage process, using whole practice team
- Signposting to alternative services
- Safety net processes
- Appointment set ups: 25 limit, 15 minutes
- Monitoring and review: experience and numbers (qual and quant)
- Reviewing job plans and clinics as appropriate
Source: BMA
‘GPs and practices are seeing nearly half the of the country’s population every month’
system clearly not functioning.
I suspect the contract change to have to give appointment or signposting at first contact and drive to full digital triage have driven this plus secondary care failure, workload dump and maybe the government telling everyone what to do for 2 years during lockdown has ruined the ability to people to self care.
Not looking good.
The BMA in its plodding way blunders into checkmate, by fighting the wrong battle. Instead of IA re GPs pay and work (which the media will represent as “greedy, lazy GPs”), they should have campaigned against the destruction of primary care (and be seen as fighting for patients and general practice).
Meanwhile, the Govt works on a secret plan to salary all GPs….
The most important really is to increase the proportion of patients who are seen IN THE MOST APPROPRIATE PLACE and by the most appropriate clinican (if any). Many rural GPs could re-increase the range of presentations dealt with if supporting services were re-instituted, such as cottage hospitals and MIU/minor AE Units, dressing clinics, etc This would save bigger AEs, and thence reduce ambulance waits and free up GP time. At the moment, far too much GP time is essentialy wasted dealing with problems arising or caused by secondary care, including waiting times, but also very poor communications and handovers from secondary care, and incompleted ‘care episodes’. if you send me XRay images (and plaster) I can plaster minor fractures and provide follow-up. But I need an assistant to clean and suture wounds, cannot do alone, especially for free! The ‘internal market’ should have resulted in funding going to practices that did extra stuff, but it resulted in funding being withheld until practices withdrew from doing it for free!