ICS row breaks out over patients being shunted to GPs

Norfolk and Waveney Local Medical Committee has set out a series of concerns about contractual breaches by providers relating to the interface with GPs, in a letter to system leaders.

The row represents the latest local example of interface problems which national GP leaders and think tanks have long highlighted as an issue.

The arguments centre around the volume of work being passed on to primary care, including expecting GPs to check and act on test results organised by secondary care; GPs being asked to undertake additional tests, as well as trusts rejecting “reasonable” referrals.

LMC chair Wendy Outwin published a letter last month, saying: “The consequences of having other providers regularly breaching their contracts is overwhelming for both GPs and practice staff and is impacting the patients of Norfolk and Waveney and the quality of their care.”

She claimed the N&W integrated care system was “failing to address the ongoing problems [and] not meeting its responsibilities in managing the secondary care primary care interface”.

She added: “The future of general practice in Norfolk and Waveney depends, in no-small part, on these areas being addressed at the very earliest opportunity, to reduce some of the enormous pressure on GPs and their practice staff, who are at breaking point.”

The ICS acknowledged that interface problems were a live issue, but added: “Work is ongoing with local acute providers and primary care colleagues to address the interface priorities, with some good progress made to date.

“Gap analyses confirm that these sort of contractual breaches represent less than 0.1 per cent of all referrals however, we have a system in place to encourage primary care colleagues to report and share these so that individual cases can be addressed and we have a rolling programme of work to continually address these.”

Dr Outwin argued the “gap analysis” work did not fully represent where all the gaps were, and that additional pressures were being shunted onto primary care.

She told HSJ: “In one working day last week, I saw 27 patients face to face, four of whom consulted solely due to being ‘lost to follow-up’ at the hospital or waiting months (despite one expedition letter being sent by the GP) and one who consulted because she had been discharged (despite worsening clinical problems) due to the hospital not being able to contact her on one (wrong) telephone number for her appointment.”

She said these “situations took up 75 minutes of my appointment time, preventing access for other patients and of course causing distress for the patients themselves”.

She continued: “More GP admin time was then taken chasing up the provider. Ironically, this is the same provider who cited no issues with their gap analysis. My experience yesterday is typical, as reported both locally and nationally by GPs.”

The LMC said “none of our local providers have [carried out the gap analysis] satisfactorily in our view and the [ICS] has not challenged them on this”.

A Policy Exchange report published last year estimated “at least 15 million GP appointments per year [were lost] to managing issues with the breakdown of this interface” the previous year alone.