Hospital doctors should not ask GPs to organise investigations during collective action, says BMA

Secondary care doctors should ‘refrain’ from asking general practice to organise investigations and specialist tests during the ongoing GP collective action, the BMA has said.

The union’s GP committee has asked hospital doctors to ‘support’ GPs taking action by refraining from asking for their help with non-commissioned work, including arranging tests and investigations.

In new guidance, it warned that actions taken by practices could ‘impact those working in hospitals’, including through work being redirected to emergency departments, congestion within elective and discharge pathways, and higher referral rates and administrative workload for consultants.

But it explained that collective action represents a commissioning dispute with NHS England, and is therefore not directed at secondary care clinicians.

GPs do not want additional work to be ‘unloaded’ on secondary care without any allocated time or additional pay, so consultants should ‘pressure’ the trust board and ICB to commission resources for general practices to do this work.

The guidance said: ‘GPs may decline to investigate or prescribe due to a lack of a locally commissioned or adequately resourced pathways. GPs do not want work to be unloaded on you without any allocated time or additional pay.

‘You and your LNC can pressure the trust board and ICB to commission resources for general practices to do this work, in partnership with the LMC, or for the work to be resourced and included in jobs plans for secondary care colleagues to do.

‘Ensure clear and timely communication and share essential contact details with GPs after patient consultations. Refrain from asking general practice to organise investigations and specialist tests.’

The GPC also said that if a GP requests advice, consultants should offer this but that if the patient’s needs would be ‘best met’ by a referral, they should ‘advise accordingly’.

It also explained that GPs do not currently get resources for using consultant advice to prevent secondary care appointments.

It added: ‘Your trust is allocated resources for Advice & Guidance as if it were an outpatient appointment, but GPs do not get resources for using your advice to prevent outpatient appointments/escalation to secondary care.

‘If you are not receiving job planned time for responding to GP requests for advice or guidance, you can raise this in job planning negotiations and with your LNC.’

Consultants should also offer med3s (fit notes) to all working-age patients upon discharge ‘as medically appropriate’, in alignment with hospital contract obligations, as a way of supporting GP collective action.

The guidance added: ‘We appreciate your support, particularly as we anticipate heightened demands during the winter season. We want the medical profession united. We will not let ICB and trust management divide us.’

This follows over five months of GP collective action during which practices have been able to choose from a list of nine options recommended by the BMA.

As revealed by Pulse, collective actions that practices can take include declining non-contractual work, switching off medicine optimisation software, refusing to engage in advice and guidance and limiting patient contacts to 25 a day per GP.

GP collective action has been estimated to cost on average £2m to each ICB, according to data gathered by Pulse.

Local GP leaders called on the BMA to ballot the GP profession on taking ‘more significant’ industrial action in November, and this will be discussed at a special LMC conference next month.