ࡱ> ?A>G bjbjَ *]8< Hxxxxxxxx1p:p$\xxxxxxxxxvxxx hxdPbfQ LMC Position Paper on Strategy for Coping with Severe GP Manpower Shortage 1.0 Background 1.1 The number of applicants for GP vacancies in Somerset has been falling for years, but until recently the supply was meeting demand. In the last few months some vacancies have attracted no applicants at all, and elsewhere GPs have elected to try to keep to manageable list sizes. 1.2 In either case GPs are likely to come under pressure to provide care for more patients than they feel comfortable with. In the current climate any extra demand may well prove intolerable, leading to resignations and hence further pressure on the remaining doctors. 2.0 Patient Allocation 2.1 The HA is obliged to provide a general practitioner for any UK resident who requests one. They can allocate at least up to the maximum list size of 3500 patients per GP. Patients can be allocated to any GP on the HA list, there is no requirement that they should be resident in the GPs practice area. It is not clear whether the GP is obliged to visit allocated patients outside his or her area the answer is that they probably are, but a test of reasonableness would have to be applied by the court or tribunal concerned. It is reasonable to visit a patient 3 miles away, but not one 30 miles away. 2.2 In theory the GP can demand that such allocated patients be removed from his or her list after 8 days, but in practice this would lead to complete chaos and it cannot be recommended. 3.0 PCT Responses 3.1 The PCOs have recognised the problem and are attempting to help. In South Somerset the salaried doctors scheme is operating, Somerset Coast is looking at using more non-medical staff, and Mendip has a high number of PMS practices. Nonetheless, no solution so far proposed will be sufficient. Experience at Somerton shows that there is no substitute for a GP principal when comprehensive primary medical care is sought. LMC Response As all GPs are well aware, family doctors now undertake a huge range of tasks outside the borders of traditional GMS practice. Many of these are either voluntary, or are contracted for separately. If GPs and practices are to survive a major increase in patient numbers they must concentrate on core business and divest themselves of the rest. Non-core work covers at least 1/3 of a GPs activity. It extends from private services to involvement in NHS management and from clinical governance the traditional IOS work. All of these could be drastically pruned. 5.0 Reducing clinical work: Position of PMS Practices GMS doctors can vary their activity very easily and without giving notice by virtue of their Red Book contract. PMS doctors will need to look at their service agreements with the HA but the informal view of the LMC is that these are likely to be exceptional circumstances that are not covered by the contract agreement, and that if the alternative to the practice withdrawing from part of its contract is the collapse of primary care, then a unilateral decision to restrict some services is a reasonable course of action. However, the PMS practice will have to demonstrate that the extra number of patients seen means that they are providing services of at least equal value to the NHS as any services that the practice is no longer providing. We would strongly advise that you give the HAnotice of any such intention, contact the LMC office for support, and take legal advice if in doubt. Reducing clinical work: Position of GMS Practices GMS GPs can at any time decide that they no longer wish to undertake some IOS activities. These might include maternity care, child hood immunisation, cervical cytology screening. It is possible that practices could stop offering over 75 checks and return the capitation supplement for these patients. Other areas of activity that can be abandoned Support for NHS Management. Involvement in PCT boards, work as clinical Leads, participation in committees or working parties at Trust, PCO or HA. Education and Training. PGEA, PDP, PPDP, CME study inside and outside the practice, medical student, house officer and registrar training. Support for nurse, health visitor and specialist nurse training. Clinical Governance Critical event reporting, significant event analysis, audit, MIQUEST reports Work For Secondary Care Clinical assistantships, community hospital bed fund or points admissions, drug monitoring (eg. Cytotoxics and antirheumaticss), anticoagulation, DVT early discharges, follow up of surgical patients, prescribing for outpatients, all certification for hospital patients, removal of sutures. Private Work Private certificates, verification of identity, PMARs, medical examinations, occupational health, travel immunisations. Extended services Minor operations, extended minor operations, hormone implants, special services: endoscopy, uroflow, dermatology clinics Research and Development Clinical Research, surveys and questionnaires, qualitative research, participation in RCGP and other groups NSF implementation CHD, Mental Health and Elderly NSF implementation, preliminary work for Diabetes NSF. Chronic Disease Managment Suggested approach for the LMC to take Each LMC area committee should monitor the local position on GP vacancies The LMC Office will keep in contact with the registrations department at the HA to get early warning of allocation surges If a serious problem is identified the LMC area committee will meet with the PCT to seek an agreed solution. If no solution can be found the area committee will suggest a disengagement strategy to practices with a phased withdrawal from non-core work that will be notified to all the relevant parties (StHA, PCT, NHS Trusts etc). The implementation of the strategy will be regularly reviewed according to the numbers of patients being allocated. If the situation eases, the committee will seek to negotiate with the PCT or HA the transfer of allocated patients to another list so that normal services can be resumed. Impact on GP practice income We believe that a GP and a nurse can manage to provide a core service on an HMO style pattern to a list of 3000 patients. The net income of the practice is likely to be greater that that derived from a normal GMS list of 1800 patients receiving a full range of services. 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