Pushing back on workload from secondary care

The NHS standard contract 2017-19 has put requirements on hospitals to shift workload onto GP practices. We provide guidance on this and letters you can use if you need to take action.

Location: England
Audience: GPs Practice managers
Updated: Monday 16 October 2023
GP practice article illustration

Many of the changes to the standard contract are as a result of ongoing negotiations between the BMA general practice committee and NHS England to get them to understand how important it is that the bureaucratic burden that all GPs are under is reduced.

For the latest round of negotiations we have agreed five key changes. Below we provide template letters in the event that hospitals are not making the changes.

There is also template letters to your CCG and trust (for LMCs) to highlight which changes have not been made, a breach of the standard contract, for them to take action.


Practice checklist

  • Develop a practice policy on how to push back on inappropriate hospital requests that breach the standard contract. Perhaps use your next practice meeting to agree this.
  • Ensure all GPs in the practice are made aware of these new standards, and use our templates on each occasion that a hospital has failed to meet these new standards. Embed the template into your clinical system for automated use.
  • Ensure that the breach is notified to the CCG using our CCG template.
  • Keep a practice record of all breaches, and the nature of the breach. Feedback the numbers and nature of any breaches to your LMC on at least a monthly basis.


Letter templates for practices

What the template letter pack includes:

  • Template response for clinic letters following outpatient attendance.

  • Template response for failure to provide fit notes.

  • Template response for issuing medication following outpatient attendance.

  • Template response for patient queries.

  • Template response for shared care.

  • Template letter from practice to CCG regarding new standard contract breaches.

Practices should also keep a record of numbers and categories of breaches, and ideally provide this information to the LMC, to strengthen local negotiations.

While this will require some administrative work from the practice, it will be less than acting on inappropriate hospital requests. It should change hospital behaviour to free up time for practices.

CCGs could also provide assistance to practices to load the templates onto their clinical computer systems, or resource practices for this ongoing contract monitoring via a local scheme, as part of their commissioning obligation to ensure delivery of these new requirements.


Letter templates for LMCs

This letter is to ask trusts for a report on what arrangements have been made to implement the changes set out in the new standard hospital contract.

This letter is to remind CCGs of the changes to the standard hospital contract and to ask them what measures they have put in place to ensure that trusts implement these, and to hold CCGs to account.

Advice for LMCs

LMCs should request for this to form a rolling agenda item at LMC/CCG liaison meetings.

LMCs should feed back examples of significant breaches to their LMC reference group lead, or to their regional GPC representative, so that we can take this up directly with NHS England.

Implementing the above will be a small, but significant step in reducing inappropriate workload for GP practices.


Template letters for clinical systems

Emis Web
  1. Download the ZIP file and copy the files within it to a folder on your computer.
  2. Open EMIS Web and select Configuration -> Template Manager (or Resource Publisher if you are on a newer version of EMIS Web).
  3. Select the "Document Templates" tab and Select "Add -> Folder" and call it "BMA".
  4. Select "Import" and import the Word documents.

We would like to thank QMasters Medical Informatics for creating these templates.


Please note, if you have previously joined this group, you will automatically have access to the new BMA contract letters.

  1. Go to Setup > Users & Policy > Organisation Groups > Wiltshire > BMA NHS Contract letters (Ardens)
  2. Click "Join group” and then turn SystmOne off and back on again
  3. To access the letters, go in to letters as normal and find the contract letters under Ardens > BMA letters

Download the templates onto your computer. Please save these to a sub-folder within the 'Template' folder.

We would like to thank Dr Michael McKenna and NIGPC for creating these templates.