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.
Waiting lists only make any sense if you know what the productivity levels are One practice may only be seeing 10 patients per GPand another 25 when do you allow a waiting list to start? Secondly for any waiting list to make the patient needs to initially be given a future date and time to expect to be seen. In Northern Ireland our secondary care have WL without end 5/10+years but actual date or time in the future There are no available figures for productivity Apply this to GP land and nobody ever sees anyone
Sounds great. A Duty Doctor system now equates to guaranteed burnout. The difficulty will be when patient 26 is turned away and suffers an adverse outcome. The messaging and recording of safety-netting re self referral to NHS 111 or 999 needs to be watertight.
Completely agree with all of this. As for productivity? Yes health care needs to be efficient but health care is not a biscuit factory where the more biscuits produced the more money you make. It doesn’t work like that. Its the exact opposite. The more patients you see the more money you spend, the more referrals you make, the more ‘demand’ you satiate. In a consumerist instagram world that demand is limitless and primary care is like a road, build a new one and in a month there will be a traffic jam. The answer isn’t to build crap roads. The answer is to continue to build safe ones and manage the traffic. “Productivity” is limited by safety and resources (this ISNT a money making business, its a money spending one) and that productivity number is somewhere around 25. Society at large hasn’t twigged this yet. Many of those running the system haven’t either. They need to be educated
And how will we know if they can wait? We’ll try and assess the urgency of their clinical problem. GP, Noctor or Receptionist? Triage doesn’t work! Can anyone show me evidence that in GP, it is clinically safe AND efficient in terms of time spent double handling vs just sorting the problem. NO WL. Just say no at 25 and divert.