General practitioner England

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Doctors set out safe working plan for general practice

Doctors leaders have outlined proposals for GP appointments to be lengthened to 15 minutes and consultations to be limited to a target of 25 a day – in a bid to stop general practice being ‘run into the ground’.

The BMA has today published Safe Working Levels in General Practice, a report which discusses measures which could help tackle rocketing workload in the specialty – and calculating what sustainable and safe working levels look like is top of the agenda.

BMA GPs committee executive team member Brian Balmer said: ‘In a climate of staff shortages and limited budgets, GP practices are struggling to cope with rising patient demand, especially from an ageing population with complicated, multiple health needs that cannot be properly treated within the current 10-minute recommended consultation.

‘Many GPs are being forced to truncate care into an inadequate time frame and deliver an unsafe number of consultations, seeing in some cases 40 to 60 patients a day. This is well above the 25 consultations per day, which is the recommended level in many other EU countries.’

The report also considers the potential impact of ‘locality hubs’ – a central facility where demand, patient lists and safe working limits would be managed for a number of local practices – and suggests GPs could benefit from the integration, collaboration and flexible employment patterns potentially on offer.

This hub model was featured in the plans outlined in NHS England’s GP Forward View, which included £500m of recurrent funding to provide extra primary care capacity and a £171m one-off investment by clinical commissioining groups from 2017/18 for practice transformational support.

The five case study hubs featured in the report cover anywhere from four to 22 GP practices – and all triage demand in different ways – to take pressure off individual practices.


Shake up

The BMA report suggests that hubs will have to be open for sufficient hours for patients to access them, and that same-day appointments will have to be offered – but that safe working limits should not be breached.

Those safe working limits, the report suggests, would include lengthening appointment times to 15 minutes to ensure all patients get the time to have a comprehensive assessment and giving GPs a target of 115 appointments per week.

The number of consultations taking place in some GP surgeries could be as high as 40 to 60 every day. The report does not suggest that the extra appointments – above the potential 115 a week target – would be cancelled, but that Government and NHS leaders should move toward the target by implementing the new hub system.

Dr Balmer said: ‘We need a new approach that shakes up the way patients get their care from their local GP practice. The consultation time needs to increase to 15 minutes with the Government providing on its promised funding to make this work.

‘As part of the package, more GPs must be put in front of patients so that the number of consultations per GP a day falls to a sustainable level. We need to learn from best practice across the UK and look at options, where appropriate, for organising GP practices into hubs, where knowledge and resources can be shared.

‘General practice in the UK cannot be allowed to continue being run into the ground: it’s time for positive change that gives patients the care they deserve.’

The BMA report concludes that a number of principles should inform the development and implementation of the hubs as plans progress – including ensuring sufficient recurring funding is in place, there is flexibility in models allowing variations for differing geographical areas, triage is properly coordinated and collaboration is supported by IT systems.

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