GP practices should move to a waiting list system for appointments as demand ‘currently greatly outstrips capacity’, the BMA has recommended.
The union’s GP committee has refreshed its ‘safe working guidance’, a document helping practices to ‘prioritise safe patient care’ when under pressure.
The guidance now includes a recommendation for practices to place patients ‘that can wait’ for assessment on a waiting list ‘if safe capacity for appointments is exceeded for the day’.
It comes after England’s LMCs voted in favour of establishing waiting lists for patients when accessing general practice at their conference in November last year.
Other measures recommended in the guidance include:
- Take ‘immediate measures’ to move to 15-minute appointments, to reduce the need for repeated consultations and ‘preserve patient satisfaction’
- Cease all ‘non-contractual work’ and divert resources to core services
- Stop taking part in advice and guidance as the use of A&G is ‘neither a contractual nor professional obligation’
- Move away from a ‘duty doctor’ system with ‘uncapped demand’, where clinicians ‘may be expected to maintain unsafe levels of patient contacts in a day’
- Engage in not more than 25 contacts a day per clinician to maintain safe levels of care, as recommended in a previous version of the guidance
- Consider closing the practice list if the limit of workforce’s capacity to provide safe care to patients has been reached
The guidance said: ‘We advise general practices to move to a waiting list system for appointments as demand currently greatly outstrips capacity.
‘There has been pressure on GP practices to provide near immediate assessment and management of all patient problems regardless of actual clinical urgency. This is impossible to maintain and not required by the GMS contract.
‘Practices are obliged by their GMS contract to provide for the reasonable needs of their patients and for the assessment of urgent problems arising in their patients in their practice area. Emergency or urgent problems can be directed to emergency departments, 999, or 111.
‘Patients that can wait should, be placed on the waiting list if safe capacity for appointments is exceeded for the day.’
Practices should have waiting lists that are ‘based on clinical need’, according to the guidance, as this is the approach ‘that exists in secondary care’, even if it means that patients with non-urgent problems ‘may wait a number of weeks for an appointment’.
‘This only formalises the already existing informal waiting lists for patients that cannot get an appointment at a convenient time,’ it added.
‘This will allow GPs to focus their resources on those with the greatest need. A patient’s clinical condition may well change whilst on the waiting list. You may consider reviewing the urgency at this point if you have capacity at your practice. Otherwise you may direct the patient to another service, such as NHS 111 or a UTC (Urgent Treatment Centre).’
Last year, Pulse revealed that NHS England does not accept ‘arbitrary’ BMA advice for practices to redirect workload after 25 daily contacts per GP.
GPs stopping to engage with the advice and guidance pathway is also one of the options on the BMA’s current collective action ballot, which will close later this month.
Where would we all be without you B.M.A ?
Many very sensible recommendations. Especially waiting lists and ditching horrible advice and guidance shambles
Sound points. Will they materialise? Probably not but 10000 more GPs and as many ARRS will be needed if they do.