GPs are warning that overstretched surgeries could close and waiting times get even longer if NHS bosses force them to take on extra work, including regular visits to care homes.
Family doctors in England claim that NHS bosses’ plans for them to assume five new duties of care from April are “unacceptable and completely unworkable” given the widespread acute shortage of GPs.
GP leaders say that practices already struggling to cope with the number of people seeking help do not have the time and staff to take on the extra work, which also includes regular reviews of patients’ drugs.
One GP in Yorkshire said: “If these plans go through this spells the end of general practice in our area.” Another said: “The only way to survive will be to cut existing appointments by 44% for our patients, with any additional work dealt with by A&E.”
The row has blown up amid mounting GP fury over NHS England’s drive to get new groupings of surgeries known as primary care networks (PCNs) to provide more preventive healthcare to vulnerable groups from April.
Dr Richard Vautrey, chair of the British Medical Association’s GPs committee, described the proposals as “unreasonable and completely unachievable”. Four out of five committee members rejected them.
GPs in Gloucestershire wrote to the county’s NHS clinical commissioning group to warn that the planned duty to carry out time-consuming “structured medication reviews” was unviable because most surgeries only have a pharmacist on duty one day a week.
They also said: “GPs do not have the time to visit nursing, residential and learning disability care homes on a weekly basis” – something which NHS England wants to start in September.
Gloucestershire CCG then wrote to NHS England that the prospect of extra responsibilities was affecting GPs’ mental wellbeing. “[They] will also accelerate the departure of senior GPs from the NHS as many of them view this as the last straw in a very challenging environment.”
An analysis by GPs in Berkshire, Buckinghamshire and Oxfordshire estimates that discharging the new obligations could cost surgeries more than £100,000 each a year due to the extra work involved.
About 1,250 PCNs are due to start work in England in April. Each will include a number of local surgeries and cover populations of 30,000-50,000. NHS chiefs hope that greater joint working between individual practices will help overcome the lack of GPs, improve care and let surgeries offer a wider range of services.
The £1.8bn scheme to create PCNs is a key part of the NHS long-term plan and the new GP contract. Under draft specifications for the new duties, GPs would also have to do more to boost early diagnosis of cancer, provide more personalised care and ensure the right treatment at the right time. In return surgeries will get extra money to hire additional staff such as pharmacists and social prescribers.
However, GPs in Humberside have written to the BMA calling the proposals “the single most repressing document for a decade … didactic, central command and control that does nothing to alleviate workforce pressure.”
Some surgeries are likely to withdraw from the PCN scheme altogether unless it is rethought.
In a report (pdf) last week by the NHS Confederation, clinical directors of PCNs expressed serious reservations about the viability of NHS England’s plans for care home visits and drug reviews, which GPs may have to do with as many as 25% of all patients on their list, they said.
“With such specifications set to require a disproportionate amount more work for GPs when compared to the additional funding received to deliver them, there is a risk that practices within PCNs will question their involvement,” the doctors said.
Prof Martin Marshall, the chair of the Royal College of GPs, has criticised the plans for involving “unrealistic expectations” and warned that PCNs “should not be overloaded with work before they have had time to mature, or they will fail”.
NHS England has acknowledged that the draft specifications have caused deep unease among GPs and committed to rework them. It will try and agree a mutually acceptable compromise with the BMA over the next two weeks to defuse the row.
Matt Neligan, NHS England’s director of primary care and system transformation, said last week that the large volume of feedback during the recent public consultation on the plans “tells us we need to make changes”.
