GPs say they are having to provide more and more tests and treatments for patients that, before the pandemic, would have been carried out in hospital settings, according to a new BMA survey1.
Due to reduced numbers of patients attending hospital, family doctors across the country are now being expected to perform blood tests for hospital outpatients, prescribe medication that would normally be given in secondary care, and complete tests before making a possible cancer referral, which could lead to delays in treatment.
This is often because workload has also dramatically increased for struggling secondary care staff as they continue to battle against Covid-19, not helped by the lack of digital solutions to either carry them out while in hospital or to find alternatives in the community.
In fact, half of more than 2,000 GPs responding to the survey said that they are having to now provide care that would normally be delivered by secondary care colleagues2.
And a further 81% said that they have been asked to carry out new investigations and manage ongoing care, which would also usually be done in hospitals, further adding to GPs’ growing workload3.
This overflow is not only because the NHS is currently operating in the middle of global pandemic, but also, and fundamentally, because of a lack of robust IT systems and digital solutions to help secondary care colleagues to complete necessary tasks, leading to work transferred to GPs without sustainable services being put in place.
On top of this, GPs are still facing intense resource shortages. A staggering 80% of GPs still say they need an increased supply of face masks for staff and another 69% say likewise for patient face coverings as the NHS returns to increased face-to-face appointments4.
The extra work and lack of support, on top of the challenge of the pandemic, is likely to explain why 28% of GPs surveyed feel as though they are currently suffering from a form of depression, anxiety, stress, burnout, emotional distress, or other mental health condition, and that it’s been worse while working during Covid-195.
One GP, working in North London, told the BMA: “Letters [from hospitals] stating that ‘due to the current situation’ they don't want the patient to attend their hospital for blood tests, [ask] ‘please can you organise these blood tests in the community’.
“We have never had a commissioned community phlebotomy service and we certainly don't have one now. Our patients have to attend hospital for blood tests, so we have to write to them to explain and again, it takes time to do this.”
Another, from Hertfordshire, said: “Our CCG is starting to say that they will be looking at ways of changing how they work post-Covid. One of their suggestions is that they will open up more pathways for 'advice and treat'.
“My concern is that as referrals will all be pushed into these categories, we as GPs will be contacted by secondary care and asked to arrange this, that and the other, and then get back to them with the results. Essentially becoming House Officers to secondary care and massively increasing our workload.”
The survey comes as the BMA’s General Practice Committee England issued a paper, Trust GPs to lead6, which outlines five key principles for change in general practice after the pandemic, including an agreed framework that reduces the need for practices to re-input information from hospital colleagues’ correspondence onto their own systems.
Dr Richard Vautrey, GPC chair at the BMA, said: “The NHS was always going to see a drastic increase in patient demand as Covid-19 arrived in the UK, but this crisis has truly shone a light on the lack of robust IT systems across the health service and the tsunami of extra work increasingly placed on GPs as a result.
“This needs rapid action to deliver long-term solutions to improve the interface between secondary and primary care, and make sure we have the digital infrastructure in place to stop unnecessary prescribing, duplication of workload and extending patient pathways.
“The longer this goes on, the more at risk we are of losing talented healthcare professionals which is why we desperately need to reduce the burden of unnecessary bureaucracy and regulation such as CQC inspections, put in place better digital systems, and provide general practice with the funding needed to deliver new services.
“Crucially though, we need to trust GPs as clinical leaders and give them and their teams the greater autonomy they’ve been afforded during this pandemic to bring patient care into the twenty-first century, where video consultations, for example, are readily available and red tape limiting change is dramatically reduced.
“If this pandemic has taught the Westminster Government anything, it should be that the NHS must be properly joined up and resourced at all times. Not only in preparation for something as serious as Covid-19, but also for after the crisis has subsided so that staff can continue to give patients, both in the community and elsewhere in the system, the safe, high-quality care they need and deserve.”
Notes to editors
- 2,351 GPs took part in the survey between 16 and 18 June.
- When asked, “Since the Covid-19 pandemic, has your practice been required to deliver patient care that would normally have been the responsibility of the secondary care system?” 52% answered yes, more than before this pandemic, and 18% said yes, but no more than before the pandemic.
- When asked, “Which if any of the following best describe changes to the care you/your practice has delivered since the pandemic?” 81% said they had been asked to carry out new investigations and manage ongoing care, which would normally have been done in hospitals. A further 74% said they’ve been asked to re-refer patients who are yet to be seen in hospital due to the pandemic.
- When asked, “Will your practice need to increase supplies of facemasks (for staff) or face coverings (for patients) as the NHS returns to providing more face-to-face appointments?” 80% said yes to fluid-repellent face masks, five per cent said no, and 15% said they didn’t know. 69% said yes to face coverings, seven per cent said no, and 24% said they didn’t know.
- When asked, "During this pandemic, do you consider that you are currently suffering from any of depression, anxiety, stress, burnout, emotional distress or other mental health condition relating to or made worse by your work?" 28% said yes, and worse during this pandemic than before, with another 15% saying yes, but no worse than before the pandemic.
- To view the paper in full, please see the PDF attached.