Workload for GPs and practice staff in primary care, both in and out of hours settings, has rapidly grown over the last decade and is reaching a level that is unmanageable and unsafe for patients. With a rise in underfunded workload shifting from hospital trusts to general practices, the over burdensome and unnecessary bureaucracy of regulatory reporting, inadequate prescribing and record keeping systems, and the inability of practices to individually determine their own safe working limits, GPs are struggling to cope with the demand being placed on them to deliver a service in a system that is ill-equipped to meet rising patient demand.
Unmanageable and unsafe workload is the primary reason behind doctors leaving general practice and is leading to a series of serious issues including practices closing to new patient registrations, practices closing altogether, GP burnout and patients being put at risk of receiving unsafe care.
- Empower practices to define capacity limits for safe working
- Develop warning systems for practices to use to alert others in the local area when they have reached safe working limits
- Create locality hubs managed by practices, to provide alternative mechanisms to meet the urgent needs of patients when local practices have reached capacity
- Enable and support practices to limit registration on the grounds of patient safety when necessary
- Deliver a reduction in bureaucracy and duplication caused by CQC, GMC, NHS England and other national regulators, which take precious time away from direct clinical care
- Create community locality teams that include GPs, community nurses, pharmacists, geriatricians and other secondary care specialists, to provide coordinated care for vulnerable housebound patients and those in residential and care homes
- Establish direct access for patients to self-refer to services such as physiotherapy, mental health, podiatry, ophthalmology and maternity services
- Consolidate and ensure the universal delivery of changes to the hospital standard contract intended to improve the primary-secondary care interface
- An extension of electronic prescribing systems to enable specialists in secondary and tertiary care to prescribe and be responsible for drugs they initiate
- Ensure that all DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) forms are completed in secondary care settings prior to patient discharge
- Establish a common and accessible electronic record with built in safeguards within local healthcare systems.
- Deliver an increase in GP and nursing clinical support for NHS 111 to ensure that patients get the care they need without the need for onward referral
- Introduce universal provision of social prescribing schemes
- Provide greater access to Citizens Advice within each locality to enable patients to get support with benefit claims
- Remove the GP’s role in assessing eligibility for bus passes, parking badges, housing, gym membership and sports activities, and other non-NHS work and ensure that responsibility for this is taken on by the appropriate requesting organisation (e.g. local authorities and CCGs)
- Establish a clear definition for collaborative service payments that is adequately funded and enforced
- Establish sustained patient empowerment and educational programmes to increase confidence in self-care
Outcome for patients
Reducing the workload burden on general practice is essential if GPs are to continue to provide safe, high quality care to their patients. Working with patients as partners in this task is imperative, giving people greater confidence to manage their care without the need to see a GP, whether for self-limiting illnesses or longer term conditions. In the face of growing patient demand, practices must be empowered to protect both their GPs and patients from unsafe levels of workload.
The national policy drive to provide effective preventative care in community settings is vital. In parallel, it is crucial for patients to have access to generalist and specialist care, and non-clinical services close to their homes to help them to manage complex conditions and multiple co-morbidities better. Combined with improved outcomes for patients, it is anticipated that resilient community locality teams could reduce workload in secondary and urgent care settings and cut the number of emergency care episodes in hospitals. Similarly, increased expert clinical input into NHS 111 would deliver more appropriate and timely advice for patients.
Next: National core contract
Saving general practice
With an insufficient workforce, a funding plan that is no longer sustainable, a growth in population and a sea-change in the level of complex cases being presented, urgent steps need to be taken to save general practice.