England’s local medical committees have voted in favour of establishing waiting lists for patients when accessing general practice.
England’s LMC conference today also ‘asserted’ that ‘NHS England’s use of the term “arbitrary” when referring to the workload limit is disgraceful’.
Instead, the BMA’s safe working limit should be a ‘red line’ in upcoming contract negotiations, the conference ruled.
And it demanded that NHS England ‘make suitable provision for all practices across England to divert urgent workload when their daily safe working limits have been reached’.
The LMC conference also ‘encourages the establishment of waiting lists for routine GP appointments in order to reveal, and to go some way toward quantifying, this demand and hidden workload’.
Pulse exclusively revealed in August that NHS England does not accept ‘arbitrary’ BMA advice for practices to redirect workload after 25 daily contacts per GP.
This was from a Pulse interview with national primary care director Dr Amanda Doyle, discussing the 2023/24 GP contractual mandate for practices to to offer an ‘appropriate response’ to patients the first time they get in contact.
Dr Rachel Ali, from the GPC, told the conference: ‘It is unacceptable that NHS England has used the word arbitrary for us trying to protect ourselves. It’s rude and disgusting. We are beyond safety and they have no plans to save is and no bright ideas.’
Meanwhile, speaking in favour of workload capping, Dr Connor Gorrard-Smith from Kent LMC said:
’There seems to be no endpoint in jobs on sometimes and tasks continue to be bounced on you. All this pressure is leading to exhausted GPs and reduced morale. We’re at a tipping point if changes do not get made more and more GPs will leave or retire and the people that will be left will have a higher workload.’
And Dr Roger Scott, from Liverpool said: ‘We have to have approved quality back-up options when we are fully booked for urgent stuff. I agree a safe limit is required but I also feel that for certain patients I am the best person to see them.
‘Until we’re adequately resourced we have to be supported to sat enough is enough and defended when the inevitable complaints arrive.’
However, speaking against capping, Kent LMC’s Dr Zishan Syed said: ‘We have to stop justifying figure of 25 contacts to NHS England. We are seeing far more patients than our European counterparts. Something radically different is required.
‘There is a simple answer to access and capacity and that is fund us properly.’
Also this morning, LMC delegates instructed GPC England to ‘seek to establish the absolute minimum number of GPs (by WTE) that are required to meet the basic needs of a standard population size’.
This should ‘provide a dataset that complements and gives context to the new OPEL type GP alert systems being established’, the motion added.
And should ‘assist the GPC England executive to hold NHS England and the Secretary of State to account when they fail to meet their obligation to ensure the provision of primary care services’.
This would ‘clearly demonstrate the superior quality and value created by traditional general practice compared with corporate and private sector alternatives reliant on “GP lite” models,’ the motion added.
Delegates also voted for practices to be protected from ‘inappropriate adverse CQC criticism about perceived lack of ‘access’ caused by inadequate resourcing to meet demand’.
Dr Ben Lees, from Gloucestershire LMC, proposing the motion, said: ‘This would empower the BMA to hold NHS England and secretary of state accountable for their dereliction of duty and their failure to provide adequate clinical staffing.
‘We must advocate for a healthcare system that prioritises quality, patient-centred care over profit margins.’
Delegates objecting the motion argued that one size doesn’t fit all throughout the country and that this data could could be ‘a stick to beat us with’.
But Dr Lees said: ‘The sticks are out there already. If we write the document we’re in charge with what it is and what it looks like. I’d rather we were in control of that.’
Motions in full
That conference asks GPC England to seek to establish the absolute minimum number of GPs (by WTE) that are required to meet the basic needs of a standard population size, and collate these statistics, in order to:
(i) provide a dataset that complements and gives context to the new OPEL type GP alert systems being established – PASSED
(ii) assist the GPC England executive to hold NHS England and the Secretary of State to account when they fail to meet their obligation to ensure the provision of primary care services – PASSED
(iii) clearly demonstrate the superior quality and value created by traditional general practice compared with corporate and private sector alternatives reliant on ‘GP lite’ models – PASSED
iv) protect practices from inappropriate adverse CQC criticism about perceived lack of ‘access’ caused by inadequate resourcing to meet demand. – PASSED
That conference asserts that NHS England’s use of the term “arbitrary” when referring to the workload limit is disgraceful and reasserts that the demand pressure on general practice has long since exceeded the threshold of safety, and:
(i) argues that simple quantification of appointments is disingenuous and needs more nuanced classification to reflect clinical complexity and value of time spent – PASSED
(ii) supports the BMA Safe Working Guidance and calls for safe working limits to be considered a “red line” in contract negotiations, and for wider system overflow support to be mandated where OPEL reporting systems are indicating high levels of demand on practices – PASSED
(iii) demands that NHS England make suitable provision for all practices across England to divert urgent workload when their daily safe working limits have been reached – PASSED
(iv) supports a new above-practice triaging service to manage excessive demand on general practice, which must not include the option to refer back to general practice – PASSED as a reference
(v) encourages the establishment of waiting lists for routine GP appointments in order to reveal, and to go some way toward quantifying, this demand and hidden workload. – PASSED
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READERS' COMMENTS [8]
Please note, only GPs are permitted to add comments to articles
an absolute minimum patients per GP would not work everywhere :
In a city with access 24 hours to several A&Es, walk-in centres, 24-hour pharmacies, gyms and sports clinics, dentists, etc, a single GP might easily manage 3,000 fit young healthy tech-savvy adults who can do IT-access and do not need meds monitoring; in a rural area, you may only have 500 patients, but because of isolation and lack of other services, you need more than 1 GP to serve that low number. If they are rural, elderly, hard-worked, without internet signal, and exposed to risks of working up mountains with animals, lacking dentists, podiatrists, and not only the village A&E but even the minor injuries unit and hospital ward have been shut down, and OOH says ‘go to nearest A&E’, they have nothing if they do not have at least one GP, and if a full time GP is 56 hours per week, a week of 168 hours is at least 3 GPs. If we agree with NHSE that ‘full time’ for a GP really is only 26 hours (what they officially pay for in contract ! ) then you actually need 7 GPs in each location. And possibly an emergency motor-boat as well for flooded roads.
DC, which bits of your grumble are actually tongue-in-cheek? The motor boat for GP?
By the way resource saturation level will only get far worse, not only in NHS, but also in police, prison services, housing, social services, schools, roads and roads/climate pollution etc: legal (‘controlled’??) net immigration was announced today as
heading towards a Million people, almost 800,000) ( this was previously underestimated, so how do we know the correct figure is perhaps even greater ), and the migrants cannot all be helping out/working in hospitals and GP surgeries will they?
So perhaps, DC, you may need 2 or 3 motorboats (or more if necessary, so they can be properly maintained at times).
(or hopefully learn to swim, and not drown in work, Haha).
The strain on all resources, including NHS, is perhaps going to get worse for all sizes of GP practices, large or small, under this Tory government; that is supposing they have not underestimated their figures again, in which case things get far, far worse.
Fleet of GP motor boats required, eh?
What an incompetent bunch GPC are. Just few weeks ago they flushed us down the toilet by negotiating the salaried pay uplift of 6% based on delusional idea that only 44% of GMC goes on staff salaries (when average in England is around 70%). But now they are drawing red lines over completely made up arbitrary figure of 25 (contacts a day).
How do you define a “contact”, you GPCidiots? Does a case of a cold in a healthy young man I saw f2f and that took me 3 minutes to deal with count as contact? Or a complicated polymorbid case I spent half an hour on thinking about what to advise but didn’t need to see in person qualify?
Thanks Dr Sayed, you seem to be able to grasp the idea that funding us properly is the answer. So how did you&co agree to the 6% “deal” is impossible to understand. Your incompetence is what allows NHSE to shit on us and remain confident that next day we will all turn up and ask for more, as contracted.
Well, luckily it looks like GPC vote resolutions are as relevant and impactful as Tories budget. Nobody cares.
Agree SB the Tories and the GPC are hewn from the same material,dont want to slip on it.Dont pay the BMA to represent you.Same every year echo chamber statments with no action.
It is your shop and you need to manage it.
SB, it’s all too easy to sit behind your keyboard and pseudonym and criticise “what an incompetent bunch”.
Not one of us is perfect, and things can always be done better. So I hope you’ll be rolling your sleeves up and standing for election to GPC, so you can show “you&co” how things should be done. Otherwise you are just “outside the tent, pissing in”.