As part of our investigation into delayed patient communications, in this piece Essex LMC’s chief executive Dr Brian Balmer explains what practices and LMCs can do if they experience similar problems
If a similar problem becomes obvious in your area, GP practices should know that this is a major patient safety issue, and that if it isn’t sorted out, someone will pin it on them.
‘Why didn’t the GP respond to X letter?’ If you never saw the letter, you have a problem. This is therefore a potential liability issue for practices.
When it happened in Essex, it took a significant amount of time for the trust to realise that GPs would be at the heart of fixing the issue. And that was the first mistake.
There was an assumption that GPs were going to fix the problem for very little money, without even noticing that this had been dumped on them. That was the second mistake.
We had to explain to the trust very carefully that somebody had to put some significant time into this and that had to be properly resourced. They finally asked us to price it, and we roughly agreed a sensible programme. We also had a few badly affected practices who tested the recovery process and the resources it required.
It was important to stress that practices couldn’t be forced to do it. There had to be an opportunity to do it if they wanted to, if they thought they had the resources. Some practices said that they preferred to do it themselves.
We had to prioritise what we thought was the biggest danger. We came to the conclusion that we had to deal with the most recent letters first – this would be the patients you might have just missed – and then work our way backwards in time.
Something we insisted on was to have the same process, right through the system – a consistent process and uniformity across the GP practices that were working through it. The recovery work not carried out by practices was performed by one of our GP Companies.
NHS IT in hospital trusts is staggeringly inefficient. It is planned in complete isolation. It has been horrifying over the last year or so to discover just how bad it is, in some ways.
If you are asked to deal with something similar in your area, make sure your practices are engaged with you in pricing it properly, and say to practices that they don’t have to get involved. We do not have to always clean up the mess created by others. Many practices will do it, but make sure they get resources to do it properly; if they don’t get resources, how can they do it properly? We are not charities.
Dr Brian Balmer is chief executive of Essex LMC
These letter backlogs are a contactual breach by the Trusts, and yet they seem to face no penalties.
Furthermore, they seem to hold no duty of candour in regard to their performance in this area: wherever problems have come to light it is usually very late and only after such a huge backlog has been created that the Trusts no longer feel able to cover it up.
I would like GPC to negotiate a Duty Of Candour in this regard – let’s have every department in every Trust produce regular updates: light is a wonderful disinfectant. That way Trusts will take it seriously and take early action to resolve any problems.
I would also like GPC to negotiate a national arrangement for funding any workload to GPs, whcih should come (as disincentive) out of Trusts’ bottom lines. Let’s say £5 per letter viewed, and £45 (the price of an appointment) for any letter requiring action.
Well done for negotiating funding in Essex, Brian, but this is a widespread national problem and a significant patient safety issue, and I think it should have a national approach to fixing it.