GP leaders have set out a comprehensive list of requests GPs should ‘decline’ and send back to hospitals, in a bid to tackle workload dump.
A new document produced by Humberside LMCs summarised the ‘most common interface workload transfer’ from other providers to GP practices, as well as their recommended response.
The LMCs have argued that such requests from hospitals and other providers represent a ‘contract breach’, based on the NHS standard contract requirements.
Pushing back against workload transfer is a key feature of the BMA’s ‘menu’ for collective action, which commenced this month.
The options for collective action, which the BMA said would not breach the core contract, included withdrawing participation in advice and guidance (A&G) and declining to use referral forms.
Under the interface guidance from Humberside LMCs, GPs should reject any requests to action onward referrals from one provider to another, or to review or action any tests ordered by another provider.
Practices should also decline requests to prescribe medication for pre-operative care or ‘shortly’ after discharge.
Humberside LMCs emphasised that these are ‘suggested actions’ and should depend on the situation.
‘There will always be situations where clinical urgency justifies intervention despite a contract breach by a provider,’ the document said.
According to the LMCs, the most common ‘interface issue’ from the local acute trust in Hull was requests for GPs to make onward referrals, while for community services the top issue was ‘difficulty making referrals to services’.
Requests GPs should decline
- Finding/reviewing/actioning results of tests ordered by others
- Doing work which is funding by a local enhanced services (LES) contract that the practice is not signed up to
- Paediatric phlebotomy
- Arranging urgent imaging on behalf of another provider (unless clinical urgency justifies intervention)
- Booking repeat investigations following care at another provider
- Use of referral forms – write an appropriately worded clinic letter instead
- Requests for images taken using dermatoscopes prior to patient referral
- Requests to commence shared care
- Locating delayed discharge or clinic letters
Source: Humberside LMCs
In the case of delayed letters, the document told GPs to redirect the patient to the provider and to consider providing a template letter reporting the delay to the ICB.
Earlier this year, a report by the same group of LMCs claimed that over £4m of NHS funding is wasted on ‘interface’ issues between primary and secondary care such as workload dump.
This was based on estimates that GPs deal with 6,600 interface problems across the Humber region each month, amounting to over 1,800 clinical appointments per week.
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And ‘dumping’ on Locums ?
Partners will just delegate this shitty job to salaried. Of course noctors will just go for their lunch break instead of chasing up anything.
Make the ca
This was based on estimates that GPs deal with 6,600 interface problems across the Humber region each month, amounting to over 1,800 clinical appointments per week.
So that’s 24 GPs working 10 sessions a week for the ICB/Hospital/Community trust, in one region
https://www.cheshireandmerseyside.nhs.uk/posts/consensus-on-the-primary-and-secondary-care-interface/
We managed to agree terms with the hospital clinicians. It helped a little bit with the “us vs them” feeling (we rarely have the opportunity to meet) and everyone has professional buy-in, so on the odd occasion something is forgotten we write with a polite reminder. There aren’t many repeat offenders.
I am interested to see what the outcome of “decline repeating tests after hospital discharge” will be. It seems to me every discharge letter ends with “recheck FBC/U&E/LFT in 2-14 days and consider restarting BP meds if XYZ, normoglycaemic in hospital please review for restarting Metformin, etc” and it’s a reasonable volume of work.