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14th December 2021

Inappropriate workload shift review

The NHS Standard Contract – Provider interface 

Inappropriate workload shift to General practice by other Providers is not new, it is a long-standing issue which has grown over decades to become ingrained into everyday practice. 

The practices we serve across Salford and Trafford have reported a significant increase of workload shift over the last 12 months exacerbated by the Covid pandemic, due to services being paused, with variable rates of services’ reinstatement between Providers, as well as through the introduction of new systems by Providers to ‘build back better’, resulting in a further shift of work inappropriately to General Practice, perhaps unwittingly.  

Unfortunately, as a result, there are a number of consequences, not only for GP Practices and their patients, but also for the Providers themselves, affecting patient safety, quality of service and reputation.  

We do not believe it is a deliberate attempt by Providers to offload work, but rather assume it has arisen as a result of Commissioners and Providers not being fully aware of the obligations both parties have under the NHS Standard Contract, consequently becoming the norm and going unaddressed. As a result, and appreciating all organisations are under immense pressure, the LMC has undertaken a review in order to understand the extent of the issue at Provider, specialty and, in some instances, clinician level, to enable everyone to understand the concerns in an evidenced way. The results provide some insight into the severity of the issue, and specifically the tasks which are being inappropriately transferred to GP Practices. We have also included in a single document recommendations for Partners to review, reflecting on their contractual obligations to avoid transferring tasks and clinical liability inappropriately to General Practice. We continue to receive clinic letters from Practices daily, which we are logging and are able to share live examples with those who are in a position of influence to change processes and behaviours within their organisations. 

The NHS Standard Contract (the ‘Contract’) is published by NHS England and is mandated for use by CCGs and NHS England for all their clinical services contracts, except for Primary Care services. It exists in order that Commissioners and Providers operate under one clear and consistent set of rules, which everyone understands. It is designed to deliver high quality, safe and cost-effective services that will produce the best outcomes for patients. There are specific standards for Primary and Secondary care interface within the NHS contract, with set responsibilities for both the Commissioner and Provider, which are outlined within the attached review document and can also be found here. 

In addition to the NHS Standard Contract itself, the recently published 'Improving access and supporting General Practice' acknowledges the impact that inappropriate workload transfer has had on  General practices’ capacity,  referencing the NHS Standard Contract 21/22  that ‘Providers must assess and address certain processes that generate avoidable administrative burdens for GPs’ whilst ‘emphasising that local system plans should hold providers to account for eliminating any unnecessary redirection of activity to general practice from other providers.’

For those who aren't already aware there is work underway at a Greater Manchester level to create a set of principles for the Primary and Secondary Care interface to adopt, which will be published in due course.  Meaningful dialogue initiated with one Provider included within the review in June this year, has acknowledged our concerns and has already started to adopt new processes internally to ensure they are not only compliant with their contractual obligations, but also to reduce the associated risk to patient safety and the immense burden their processes place on their GP colleagues. 

We ask all Providers to review the findings and action the recommendations within our report, working in partnership with us and General Practice system leaders to develop a robust foundation on which to build a strong and sustainable Provider to Provider relationship now and for the future. 

Read the full review here