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gp workloadMay 25 2016

GP leader Dr Chaand Nagpaul has challenged NHS England to make sustained GP practice numbers a key performance indicator for NHS managers.

The “immediate priority must be to provide stability to vulnerable practices, or practices coping on the outside but with a fragile foundation that could suddenly collapse,” said the chair of the BMA’s General Practitioners Committee.

Dr Nagpaul was addressing last weekend’s Local Medical Committees conference, where he noted that there were 108 commitments and various funding pots in the new GP Forward View. He said that there should be local taskforce teams which can provide funding, management resources or interim clinical cover at short notice for practices having difficulties.

“This would be in a supportive, non-threatening environment of amnesty, where practices can hold their hands up to seek support without fear of a breach notice or a CQC intervention,” he said. “It should be a significant untoward incident and a failing of the local NHS if any practice needlessly closes.”

Not only would such a closure affect that practice’s patients, there would be a “domino effect of instability” on neighbouring practices, and additional costs to provide the missing services. “I therefore call upon NHS England to use the Forward View’s practice resilience programme to make it an explicit KPI for all Area Teams to ensure there’s not a single unnecessary or avoidable practice closure now or in the future,” said Dr Nagpaul.

Under the GP Forward View a national patient self-care campaign is scheduled for September to help decrease the number of unnecessary GP appointments, he noted. “This must deliver an unequivocal public facing message of the pressures on general practice, that GP appointments need to be used wisely and to empower patients to self-care both for minor ailments and as experts in their chronic disease, or signpost them to other services.”

He recognised the value of the GP Forward View, saying that “it would be simplistic to either support or dismiss it in toto, and there are several positives that we as GPC have directly influenced, and which match those in our urgent prescription.” Among the progress the GPC had achieved since it held the Special Conference at the start of the year, he cited:

  • the 2016-17 contract agreement contains no new clinical requirements;
  • the GPC rejected all NICE recommended Quality and Outcomes Framework changes;
  • workload will be reduced with the ending of the dementia enhanced service (DES), “a political sacred cow which distorted clinical behaviour”;
  • DES money has been transferred into core funding;
  • the GMS contract has an uplift of £220m to the contract value.

He also noted that the GP Forward View “was not launched with any publicity regarding routine seven day GP services, and the words seven-days or 8-8 do not appear in the document.” Calling for limits to be put on workload, he said: “We must end the current unsustainable reality of GPs working to unsafe open-ended demands and exhausting non-stop days without a break.”

The GPC has proposed maximum workload limits, and the creation of overflow hubs to support practices when that point has been reached, he added. “Neither is it humane nor defensible for GPs to be forced to manage patients with complex multiple problems in a pressure cooker intensity of 10-minute aliquots. GPs must be given longer consultation times in the interest of safe care, even if it means exposing a waiting list to see us.”

In addition to the speeches, delegates voted on motions. Among those supported were calls to:

  • canvass GPs’ views within the next three months on whether they would be prepared to take industrial action
  • establish a GPC England
  • reject a proposed cap on locum fees
  • charge a private fee for private patients and putting any profit into the practice.

Links:

BMA GPC Chair speech

BMA GPC LMC Conference

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