Stop using ‘workload dump’ A&G pathways, LMCs urge GP practices

LMC leaders have urged practices to ‘avoid using’ advice and guidance (A&G) while calling on the BMA to negotiate better advice pathways for GPs.

At the annual conference of English LMCs in London today, GP leaders voted in favour of a motion which said that the use of A&G across the country has led to an ‘unsustainable transfer of workload to general practice’.

The motion insisted that practices ‘heed’ the BMA’s GP Committee England’s advice, as part of collective action, to stop engaging with A&G unless it is ‘clinically helpful’.

It also called on the GPCE to ‘demand an obligation’ for hospital trusts to ‘provide separate advice and separate direct referral options’ for each specialty to allow GPs to choose the most suitable pathway.

Where advice and guidance pathways are in place, LMCs have called for a national ‘standard time frame’ for responses from trusts, as well as a ‘standard structure and quality of response’ which ensures any advice from specialists can be acted on contractually within general practice.

LMCs also recommended that any financial savings generated by A&G are ‘shared with general practice’ rather than only ‘absorbed by hospital trusts’.

Proposing the motion, Tower Hamlets LMC’s Dr Jackie Applebee said that the reality is that the whole scheme has been ‘a massive, stellar workload dump onto general practice’.

She said: ‘Declining to engage in advice and guidance is one of the 10 BMA collective action suggestions, all carefully chosen with safe working in mind without breaching your contracts.

‘Demand a referral and if they push back, push back harder. There is no contractual obligation to do this.

‘Lead by example, write in the advice box that you expect the patient to be seen unless you really do just want advice.’

Dr Matthew Prendergast, from Hampshire and Isle of Wight LMC, who spoke in favour of the motion, said: ‘It is imperative that we do not accept doing more with less. It is imperative we enforce the contractual position in that we are entitled to refer.’

Cambridgeshire LMC’s Dr Stephanie Betts-Masters, who also spoke in favour of the motion, said: ‘Every GP is an expert generalist and manages a remarkable amount of medical complexity for our communities.

‘We deserve to be able to ask for help from our secondary care colleagues and our patients deserve that opinion when we deem that that is the appropriate next step.

‘We know our patients best, and our concerns should not be blindly disregarded without a proper review by secondary care.’

Pulse’s recent survey suggested that a quarter of practices have stopped engaging with advice and guidance either before or after the start of collective action this year, while almost 40% are not planning on taking this action.

In November last year, NHS England said there will be no national mandate for GPs to use advice and guidance in a certain number of cases, and that local systems should design their own targets and processes.

But in June, Pulse revealed an NHS England document which confirmed that it wants to ‘optimise’ GP referrals to secondary care via an enhanced model of A&G.

The document encouraged local commissioners to ‘strengthen’ specialist advice services with an ‘advice and refer’ model which means all referrals or advice requests from GPs ‘come in through one route’.