We can’t get cover to run our practices

We can’t get cover to run our practices

BMA News

The BMA has just published a third wave of heat map survey results from its Urgent Prescription for General Practice campaign.

At a time when large numbers of practices across the country are struggling with vacancies, this heat map reveals the desperate situation of practices unable even to obtain locum cover to provide essential services to patients.

Most GP practices – about 90 per cent in England – have struggled to recruit locums in the past year. Almost half of practices (46 per cent) have had trouble finding locums ‘frequently’ and a further 40 per cent have had trouble ‘occasionally’. The South and South West are the worst affected areas, with 61 per cent and 57 per cent ‘frequently’ having trouble finding locums.

Only one in 10 practices said they did not need locum cover at all. See the latest infographics.
This inability to recruit locums is exacerbating the workload crisis in general practice, as partners and salaried GPs have to try to absorb an increasingly unmanageable amount of work.

GP locums do an outstanding job of stepping in to provide care at short notice but it is clear there is no longer enough to cover the widening gaps in the GP workforce. The Government needs to provide practices with support rather than sanction, and should make it clear to the public that the reason GP practices struggle to provide enough appointments and adequate access is because there are already too few GPs.

Crucially, this survey’s findings demand the Government addresses this GP workforce shortage head on and delivers its promised support package for general practice. We received considerable media coverage on the survey’s findings. BMA representatives conducted interviews on Sky News, Five Live, LBC and Channel Five News, with reports by the BBC and regional and national media. There has been the usual strong coverage in the trade press, both in Pulse and GP.

This means that the urgent prescription campaign has, over the course of its three separate sections, appeared in every national newspaper (including for the first wave, the front page of the Guardian), every BBC outlet (the Today programme for the first two poll releases and BBC1 Breakfast/Five Live have covered all three polls) and we have made in excess of 100 mentions in regional media and local BBC radio stations, as well as put camera crews in several GP practices.

Connecting with grassroots GPs

March has been a busy time for the BMA GPs committee executive. The team and I have been speaking at a series of 11 roadshows across England, organised through local medical committees, from Newcastle to Bristol.

These events, which started on 9 March – with just one left to go on 14 April – provide an invaluable opportunity for the GPC executive to connect with several hundred LMC representatives and grassroots GPs nationally, ensuring that GPC’s strategy and negotiations are rooted in a bottom-up perspective.

The roadshows allowed us to update local GPs on important developments such as the 2016/17 contract agreement, GPC’s vision for the future and emerging thoughts on what a rescue package for general practice would entail. However, what I always find most useful is the usually lengthy discussion, which allows the executive to understand local realities better such as the specifics of  personal medical services reviews, practice networks or new models of care, as well as the common themes of addressing excessive and inappropriate workload.

These roadshows highlight the particular strength of GPC, which is its connection with LMCs covering all parts of the UK. It helps us to make sure that we view the world through the eyes of everyday GPs.

CQC fees increases

The CQC (Care Quality Commission) has announced increases in its fees for all providers, including GP practices, from this month. This makes a mockery of its consultation exercise, as the CQC has totally ignored the responses from the BMA and other stakeholders, most of whom completely opposed these wholly unjustified fee rises.

For 2016/17, there will be an average increase of £1,839 in fees. GPC has negotiated an uplift to the GP contract value in 2016/17 to account for this rise. While this may shoulder the expense for practices this year, it does not address the true wider cost of CQC in terms of its negative impact on practices.

Our recent CQC survey reveals that preparing for inspections is taking days per month of GP and staff time away from caring for patients, with significant stress on practices, and with three in four GPs stating they are more likely to leave the profession as a result. Worse still, 9 in 10 practices don’t believe the process is even an adequate measure of quality.

Fundamentally, CQC inspections are disproportionate, bureaucratic and flawed, and this is perversely undermining rather than supporting quality patient care. The CQC should instead scale down its inspection process, and reduce costs, rather than adding to the already huge pressures on general practice.

The GPC is continuing to push the Government to replace the current CQC registration and inspection process with a slimmed-down, targeted and proportionate system, which recognises the context of the pressures under which practices are working, and within a climate of support rather than of threat and fear. Read our press release relating to the fees increase.

Hospital test results – please use our templates

As mentioned in my last e-newsletter about NHS England’s recently published guidance on standards for the communication of patient diagnostic test results on discharge from hospital, the key principle is ‘the clinician who orders the test is responsible for reviewing, acting and communicating the result and actions taken to the GP and patient even if the patient has been discharged’. This reinforces joint guidance between the GPC and the BMA consultants committee.

I urge practices to resist any imposition of inappropriate work, by using the templates designed by GPC. You can access these on our website, including:

– An existing Quality First template to reject inappropriate requests to follow up hospital investigations

– A new template to send copies of test results back to hospitals to ensure/confirm they have been actioned by the requesting clinician

– A new template to let the CCG know if the above principles are being breached, so that appropriate commissioning levers can be applied

Please tell your LMC, and seek their advice, about any such issues, and also remember that as a member you should demand that your CCG (clinical commissioning group) uses its powers to ensure no inappropriate work is imposed. I have also written to CCGs asking them to stop routine copying of hospital test results to GPs, unless they are of clinical relevance; and to be clear that the results have been seen and actioned by the requesting clinician.

I have further challenged NHS England about an apparent contradictory recommendation in the guidance — that GPs should still review any received hospital test result — as this would negate the whole purpose of this document. Read my letter here.

With best wishes

Chaand Nagpaul

BMA GPs committee chair


BMA/GPDF Primary and Community Care Workforce conference

The BMA and the General Practitioners Defence Fund are hosting a workforce conference at BMA House on 20 April, 2016.

Delegates will gain practical advice from leading experts on how to embed initiatives such as upskilling the nurse workforce, workforce planning, telephone triage and online consultation, and more, and will hear keynote speeches on future plans for general practice’s leading role in the delivery of primary and community care and how this will be enabled through central and regional investment.

I urge you to join us and participate in this very important event to shape and influence the future of primary and community care. You can find out more information about the event and how to book your place on the BMA website. Both medical and non-medical representatives are welcome to attend.

Judicial review and junior doctors’ industrial action

Today marks the first day of further planned industrial action by junior doctors, who will provide emergency care only over the next 48 hours, ending at 8am on Friday 8 April.

Last week the BMA launched a judicial review to challenge the lawfulness of the health secretary’s decision to impose the junior doctors’ contract. The basis for the review centres on the Government’s failure to pay due regard to the equalities impact prior to imposition. This comes on the back of the Government’s repeated refusal to resolve the dispute by re-entering talks.

As a result industrial action scheduled for 26 and 27 April has been escalated to a full withdrawal of labour between the hours of 8 am and 5 pm, on both days. Read more about the dispute and guidance for GP practices.

It is most disheartening that the junior doctors find themselves in the position of having to take industrial action, to secure long-term safety for patients and themselves. The obvious and logical approach is for the Government to retract its imposition, and come back to the table to negotiate a settlement. Each day that goes by in this dispute is further eroding the vestiges of goodwill from doctors, which the NHS vitally depends on. We continue to support our junior doctors. We are one profession.


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