Safe Working levels in General Practice
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General practice is in crisis, with a marked increase in workload at a time of underinvestmentand a shortage of GPs. Demand will continue to grow due to an aging population and it isessential that GPs are able to protect themselves and their patients from excessive workloadand the impact it has on patient safety and quality of care.
The BMA’s GPC (General Practitioners Committee) first discussed a Campaign for SafeWorking in General Practice in February 2016. Its report, Responsive, safe and sustainable:our urgent prescription for general practice, published in April 2016, was an attempt by the profession’s representatives to quantify the needs of the service both operationally and strategically.
Since then the NHS in England has produced the GP Forward View (April 2016)2 and theKing’s Fund has published Understanding pressures in General Practice (May 2016).3 Both papers clearly identify workload as one of the major causes of the current crisis within general practice and recognise the need for solutions.
The GP Forward View has committed to developing locality hubs (also referred to as primary care access hubs) throughout the country in order to provide additional clinical capacity.
GPC believes that the primary purpose of the hubs should be to provide sustainable support
for GPs within practices to work safely; however, as the hubs develop they would likely serve a range of other useful functions, providing a foundation for new models of care in the community and offering clear benefits for patients.
This paper has been produced to stimulate discussion, proposing a model that could be used by localities across the UK, altered and adapted to suit local conditions. It is not intended to be a complete solution to the crisis in general practice, but is a pragmatic approach to the unsustainable increase in workload. Available evidence is used to present one method for quantifying safe working levels. The paper then describes the locality hub model in moredetail, outlining the concept in the context of current service pressures and policy priorities. It also raises a variety of operationalconsiderations and highlights a small number of casestudies where a hub model is already being trialled.