Safe working in general practice
One approach to controlling GP workload through a locality hub model
This paper, which proposes a model that could be adapted to suit local conditions across the UK, has been produced to stimulate discussion. It is not intended as a solution to the crisis in general practice, but offers a pragmatic approach to address the unsustainable increase in workload.
The report offers one evidence-based method for measuring safe working levels, arguing that a GP-led locality hub model could be commissioned in areas where demand outstrips capacity. It demonstrates this concept within the context of current service pressures and policy priorities through a number of examples where a hub model is already being trialed.
Download the report
General practice is in crisis, with a marked increase in workload at a time of underinvestment and a shortage of GPs. Demand will continue to grow due to an ageing population, and it is essential that GPs are able to protect themselves and their patients from excessive workload and the impact it has on patient safety and quality of care.
Published in April 2016, Responsive, safe and sustainable: our urgent prescription for general practice aimed to quantify the needs of the service both operationally and strategically. Workload was one of the seven themes highlighted. The report called for a number of actions to address workload, including the development of ‘locality hubs to which practices can refer urgent patients when they have reached the capacity threshold for safe care on any given day’.
Since then, NHS England’s GP Forward view (April 2016) and the King’s Fund’s Understanding pressure in the general practice (May 2016) have identifying workload as a major contributor to the current crisis. The GP Forward View also committed to developing a form of the locality hub model.
This paper develops the locality hub proposal in more depth as a means to provide sustainable support for GPs within practices to work safely. However, as the hubs develop they would likely serve a range of other useful functions, providing a foundation for new models of care in the community and offering clear benefits for patients.
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Locality hub key principles
Locality hubs offer a GP-led model that could be commissioned to help manage
demand and support GPs to practice safely. Based on considerations outlined in the report,
and on experiences described in the case studies, the following principles should inform the
development and implementation of the hubs:
- Sufficient recurrent funding: Recurrent funding channelled through practices,
which provides sufficient additional capacity, is essential if hubs are to provide
- Flexibility in the model according to local need: The model should be developed
and adapted according to local patient need, structures and geography.
- Core opening hours: Hubs must be open during core hours to effectively manage
workload across practices and, taking into account local demand, could also offer
- Co-ordinated triage: Practices will need to agree locally how to work together
to provide a co-ordinated and consistent triage process, learning from service
evaluations and emerging good practice.
- A range of services: Hubs should make use of the wider healthcare workforce to
provide the necessary additional capacity and reduce demand on GPs
- Collaboration supported by IT systems: Appropriate IT systems must be put in
place to enable the full sharing of medical records. Localities should be supported in
learning from the numerous examples across the country where this already works
Appointment pooling schemes and hub systems case study
Responsive, safe and sustainable: our urgent prescription for general practice
Our response to the GP forward view
Urgent prescription for general practice
Quality first: delivering safe patient care