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Some Lancashire GPs are carrying out consultations with up to 70 patients in a single day, an organisation which represents the county’s primary care medics has said.
The Consortium of Lancashire and Cumbria Local Medical Committees (LMCs) revealed the figure at the end of a week in which GPs nationwide began an indefinite work-to-rule over funding for their practices.
As part of the so-called “collective action”, they can choose from 10 measures – including capping the number of patients each clinician deals with to 25 per day. That is the maximum level deemed safe by the European Union of General Practitioners.
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However, Faye Tomlinson, chief operating officer of the Consortium of LMCs, told the Local Democracy Reporting Service (LDRS) that, prior to the work-to-rule beginning, the figure was being “generally exceeded” across the area – with Lancashire GPs sometimes seeing more than double the safe number of patients in a shift.
“The demand is huge now – we’re hearing of GPs seeing 60-70 patients a day, which is not sustainable at all.
“[Limiting the number to 25 would mean] patients get a better, safer clinical time with a GP – and we would like more GPs to be able to do that. But because of the funding that there is, they can’t – there aren’t enough GPs in the system,” Ms. Tomlinson explained.
She stressed that sticking to that maximum level during the collective action would not deprive patients of the care they need – and advised people “not to worry about phoning” their surgery if they were unwell.
“GPs are still wanting to see you. If [those choosing to cap daily patient numbers] reach that level, you will be diverted to out-of-hours [services], urgent treatment centres or 111 – so you will still be seen in a healthcare setting.”
Ms. Tomlinson added that it was too early to tell which of the 10 actions – which include refusing to take part in the “rationing” of hospital referrals and pulling the plug on “voluntary services” to cover local gaps in provision at their own expense – GPs in Lancashire were most likely to take.
The collective action permits doctors to select from the suite of measures in any number or permutation – and to do so fluidly over time – but the British Medical Association (BMA) is encouraging them to pick at least one. The organisation says the aim of the action is to protect both patients and the GP practices they rely upon.
According to Faye Tomlinson, even some of the collective action measures themselves will benefit patients.
“At the moment, local [areas] have bureaucratic restrictions in place that basically dictate how and when GPs can refer patients into secondary [hospital] care.
“For example, they might say to use ‘advice and guidance’ [a system by which GPs can seek input from a specialist] instead of doing a referral – or a [hospital] trust might say you’ve got to fill in [several] forms, which can be a huge added workload burden onto a GP.
“[Under the collective action], we’re basically saying [to GPs] if you need to refer, then you can [do so] with a letter. So in a way, this will be good for patients, because they’ll be able to get a referral if a GP thinks [one] is needed,” Ms. Tomlinson said.
No longer engaging with the advice and guidance pathway – unless it is deemed “timely and clinically helpful” by a GP – is one of the 10 collective action steps now open to them. They can also switch off ‘medicines optimisation’ software designed to generate financial savings for the NHS.
Just over 98 percent of the almost 8,500 GPs who voted in a ballot over the work-to-rule supported the move – 68 percent of the total number eligible to vote.
What it’s all about
The work-to-rule follows the imposition by the previous government of a new contract with GPs, which included a below-inflation 1.9 percent increase in funding for practices for the 2024-25 financial year.
Ninety-nine percent of GPs nationwide rejected the deal in a referendum held by the BMA, amid concern that the funding – which has to cover the operating costs of surgeries – was insufficient to ensure they remained financially viable.
Earlier this year, a survey by the Consortium of LMCs found that more than half of the 193 GP practices in Lancashire and South Cumbria were at risk of closure within the next two years because of pressure on their budgets.
What has the government said?
The health and social care secretary, Wes Streeting, said in a letter to GPs on Thursday that general practice had been “neglected for too long” – adding that he wanted to “reset the relationship” between local doctors and the government.
It came as he announced a move to recruit 1,000 newly-qualified GPs by taking an emergency measure which allows them to be funded through a pot previously reserved for recruiting “additional roles” into GP surgeries, such as physician associates, nurse practitioners and clinical pharmacists.
The Department for Health and Social Care says the change will mean hundreds of new GPs will be hired by the end of the year when they could otherwise have been left “without a job”.
“It is absurd that patients can’t book appointments while GPs can’t find work,” Wes Streeting said.
“This government is taking immediate action to put GPs to work, so patients can get the care they need.
“This is a first step, as we begin the long-term work of shifting the focus of healthcare out of hospitals and into the community, to fix the front door to the NHS.
“I want to work with GPs to rebuild our NHS, so it is there for all of us when we need it,” he pledged.
The government has also accepted the recommendation of the pay review bodies, meaning the wages of partner and salaried GPs will increase by six percent. That rise is separate to the 1.9 percent increase in funding for practice running costs which prompted the current work-to-rule.
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