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Practice managers up and down England have been complaining of extra services being ‘dumped’ on them by secondary care without the funding to support them.
Advocates of general practice say practices are entitled to say no. But should they? JULIA DENNISON investigates this phenomenon
Every little hurts
practice managers across England saddled with unmanageable workloads as a result of clinical commissioning groups shifting NHS focus away from secondary and into primary care. This paradigm shift should come as little surprise, since it plays a fundamental part in saving the billions associated with the Nicholson Challenge. But what happens when GP practices simply don’t have the resources to cope with these added extras?
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THE PAIN OF IT ALL It seems primary care is close to breaking point as it is. More than 80% of family doctors surveyed this summer by the Royal College of General Practitioners believe they lack the resources to provide high quality care, meanwhile nearly 600 of the 666 GPs surveyed by Londonwide LMCs need more practice staff but are too cash-strapped to recruit them. Comments from GPs support this. “The
admin and additional work generated by CCGs and commissioning groups is simply over the top,” one told Londonwide LMCs. Meanwhile, in a post on LinkedIn’s Primary Care Forum group, Dr Navin Thakrar, also a London GP, said hospitals were “dumping a huge amount of secondary work to primary care” including, but not exclusive to, repeat blood tests; premature discharges of patients; outpatient departments requesting supply of
22 october 2013
o this blood test. Take this ECG. Send in these forms. Sound familiar? Complaints have been mounting from
medications from GPs; and hospitals sending patients to primary care for sick notes. When you add to this the fact that practice staff are often spending more than 16 hours a week chasing up information from secondary care, and 79% of practices have seen a reduction of between 10% and 50% of their income in the last year alone, tipping point becomes a not-too-distant reality.
LACK OF MONEY
The insult to this injury lies in the recent changes to the General Medical Services contract. The Department of Health plans to phase out correction factor payments over seven years from 2014 and review Personal Medical Services (PMS) funding to reduce variability in practice funding. It also plans to implement all changes to the Quality and Outcomes Framework recommended by NICE, including those rejected by the BMA’s General Practitioners Committee (GPC) during negotiations over the last two years. This includes the end of most of the organisational indicators, requiring GPs to take on a tranche of new work to retain this funding and introducing significant new work through directed enhanced services (DESs). But Dr Thakrar, for one, says CCGs pay “meagre monies” for these enhanced services; “peanuts” for minor operations, joint injections, phlebotomy and anticoagulation services and “silly amounts” for services
rendered to restrict admissions of elderly and patients with long-term conditions. In short, there just doesn’t seem to be much of an incentive for practices to help CCGs. No wonder Dr Clare Gerada, chair of
the RCGP, fears general practice is badly hurting. “We do not have the capacity to take on any more work without the extra funding and resources to back it up,” she said in a recent statement. “GPs currently make 90% of patient contacts for only nine per cent of the NHS budget in England. Some GPs are making up to 60 patient contacts in a single day, which is not safe for patients or GPs.”
IS RESISTANCE FUTILE?
The good news is you don’t have to take it. “The practice can always say no if the work requested is not funded explicitly. You just ask the requestor to explain how they think you will fund this. If there is no sensible answer, then you politely decline the request,” Dr Laurence Buckman tells Practice Business. He says practices should never feel pressurised because “every other GP is doing it”. PCTs regularly made up this little story to impress nervous GPs but LMC officers will tell you that it was invariably used to bully practices into doing work for free. I would certainly refuse anything that is being done by a hospital, or was until they tried to dump it on you,” continues Buckman. Practices should engage their CCG to avoid these situations. “The protection
primary provider
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