Imagine if in our daily work as GPs:
- We no longer receive letters requesting a GP to re-refer a patient who misses an outpatient appointment, with hospitals instead directly liaising with patients to book another appointment
- Results of investigations requested by hospital clinicians are communicated by the hospital directly to the patient, including telephoning them where necessary. Patients would therefore no longer make appointments with GPs, for example, to find out the result of the scan they had two weeks ago in hospital, nor would we receive letters requesting us to chase up results for patients discharged, or in-between clinic appointments
- Hospitals make direct internal referrals to another department or clinician for a related medical problem; GPs would no longer therefore receive letters, for example from a chest physician requesting a re-referral to a cardiologist because the patient’s shortness of breath is felt to be owing to heart failure
- GPs always receive electronic discharge letters after an emergency department visit or inpatient episode within 24 hours, and all outpatient clinic letters are received within 14 days, so that we no longer see patients without necessary information to manage them, nor do we have to ask them to come back again after receiving the relevant correspondence
- Patients discharged from hospital are given full and adequate supplies of medication, and does not require the GP to make up any shortfall.
All of the above requirements were added to the NHS England standard hospital contract In April 2016, in response to the BMA GPs committee’s lobbying as part of our UPGP (Urgent Prescription for General Practice) campaign to end relentless inappropriate demands on GPs, wasting an estimated 15 million GP appointments annually, as well as the additional time and expense of our staff.
Use our new templates to end inappropriate bureaucratic demands
We have received feedback that, in many parts of the country, hospital providers have not yet implemented the above standards. As a result of a specific request from GPC, NHS England has written to all CCGs (clinical commissioning groups) and chief executives of NHS trusts to remind them that this must be done promptly.
However, to make this a reality, GPs and practices should take control and push back on inappropriate hospital-initiated demands, which now constitute breaches in relevant areas of the standard contract.
To make this easier for you, GPC has developed new standard hospital contract template letters as part of our Quality First web resource. The templates can be adapted for practice use, and can be embedded into GP clinical systems so that the letter to the hospital is pre-populated with patient details.
Please use these templates on each occasion when a hospital makes an inappropriate request which breaches the standard contract, so that the hospital can fulfil its obligations and take necessary action.
The following templates are available:
- Situations where trusts are adopting blanket policies to discharge patients from their service back to their GPs for re-referral when they do not attend outpatient clinics
- Situations where a trust is not undertaking onward referral to other specialties internally, but is referring back to the GP for re-referral
- A failure of a trust to notify patients in a timely manner of the results of tests or investigations, or where they ask the GP to chase up the result
- A failure of a trust to send discharge summaries by direct electronic or email transmission for inpatient, day case or emergency care within 24 hours
- A failure of a trust to communicate within 14 days after an outpatient clinic attendance appointment
- A failure of a trust to provide medications following discharge from inpatient or day-case care, where medication must be supplied for the period established in local practice or protocols.
Notify your CCG and LMC of breaches
We have produced a template proforma to send to your CCGs, notifying them of a hospital breach, so that they can be held to account as commissioners to ensure hospitals adhere to these new contract requirements.
We would also ask that you keep a record of the number and nature of breaches, and notify your local medical committee (no identifiable patient data necessary) so that we can build up a national picture of adherence to these new standards, and take up any concerns with NHS England.
We have also provided LMCs with template letters to send to CCGs and hospital trusts to ensure local implementation as an immediate priority, and to recommend to add this as a regular agenda item at LMC/CCG liaison meetings with feedback of hospital performance on these new contractual requirements.
Practice checklist – what to do next:
- Develop a practice policy on how to push back on inappropriate hospital requests that breach the standard contract. Perhaps use your next practice meeting to agree this.
- . Ensure all GPs in the practice are made aware of these new standards, and use our templates (or any of your own), on each occasion that a hospital has failed to meet these new standards. Embed the template into your clinical system for automated use (you could request your CCG IT lead to support implementation).
- Ensure that the breach is notified to the CCG using our CCG template.
- Keep a practice record of all breaches, and the nature of the breach. Feedback the numbers and nature of any breaches to your LMC on at least a monthly basis.
Please take advantage of these template letters. As hard-working GPs we should now be reaping the benefits of the contractual changes, which we have leveraged through our hard negotiations; we should not accept system failings that waste our time and appointments, and which take us away from meeting the core needs of our patients.
Moving forward, the above changes are just the first step in a wider range of measures in our UPGP to end inappropriate demands on GP practices. I shall be attending the first NHS England GP Forward Views primary/secondary care interface group this week, which is designed to address a host of interface issues between hospitals and general practice, and which are adding unnecessary bureaucracy and workload on to practices, while also unfairly inconveniencing patients.
With best wishes,
BMA GPs committee chair
BMA GP committee announces English executive team
The BMA GPs committee has announced a new English GP executive team for the next two years. Joining BMA GPs committee chair Chaand Nagpaul will be Richard Vautrey, who has been reappointed as the committee’s deputy chair, alongside Mark Sanford-Wood and Gavin Ralston.
Dr Nagpaul said: ‘There are formidable challenges facing general practice. This newly appointed English executive team will provide strategic leadership and work with a range of policy leads as part of wider reforms within GPC. This will include closer working with local medial committees to deliver on the priorities of our recent Urgent Prescription for General Practice campaign and the Government’s recently announced GP Forward View.
‘I believe this new team has the broad range of experience and skills to listen, represent and lead the profession in these difficult times.’
Dr Vautrey is a GP in Leeds and has been a member of the executive team since 2004. He said: ‘I’m committed to doing all I can to turn around the current crisis undermining general practice and to make a real difference for GPs and our patients.’
Dr Sanford-Wood is a GP locum from Devon and has been on the GPC since 2011. He said: ‘I am delighted and honoured to have been appointed to the GPC’s executive team at such a crucial time for the profession. I relish the prospect of working with the committee in the forthcoming challenges to represent all branches of general practice during a period of unprecedented change for the NHS.’
Dr Ralston, a GP from Birmingham, chair of NHS Birmingham’s Cross City clinical commissioning group and a longstanding member of Birmingham LMC, said: ‘General practice and indeed the NHS as a whole is at a crossroads and now more than ever we need to make certain that general practice has a strong voice. I am really pleased to be taking up this role and look forward to using my experience as a GP and commissioner to ensure that general practice thrives and not just survives, which is a necessity for the NHS as a whole to work well for patients.’
Performers list application delays
The BMA is aware that there have been delays in processing GP trainee applications for the performers list beyond the three-month window for applications to be processed. We understand that this has serious implications for both trainees and practices and we have sought legal advice on this.
Whatever the reason, GP trainees are not lawfully allowed to perform primary medical services past the three-month mark (ie three months after the start of their GP specialty training programme, not three months after the first GP placement), if the trainee has not been added to the medical performers list. Trainees should inform their employers in a timely manner if there is a delay in an application being progressed.
Instructions for applications are outlined by HEE on the PCSE website.
If you have any remaining concerns about how this will affect your practice and would like further advice, please call our BMA employment advisers on 0300 123 1233 between 8.30 to 18.00 Monday to Friday, excluding UK Bank Holidays.
BMA GPs committee chair Chaand Nagpaul
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The effects of austerity on people’s health
Doctors are concerned about the impact of austerity and welfare reform on health and well-being, particularly on the most vulnerable and disadvantaged in society.
The BMA has produced a briefing, Health in all policies: health, austerity and welfare reform, that aims to support doctors’ role in protecting health during times of austerity. It sets out the potential harm to health caused by austerity and the action needed to prevent it from happening.