Somerset LMC Unfunded Work Survey
Introduction
The work that General Practices are being asked to do on behalf of other organisations has increased significantly over the last few years, and this cannot continue without some recognition of, and funding for, such work. One difficulty has been quantifying the size of the problem, but certainly the steady increase means that the pre and post op Enhanced service (ES) negotiated in 2004 has long outlived its usefulness in this respect and needs re-visiting. In 2010, the LMC presented evidence to Somerset PCT that healthcare assistant and phlebotomist work done in Practices for other organisations had far exceeded the 10% above baseline agreed in the ES. In 2014 a further study quantified this as being between 25-30% of the total work done by practice HCAs and nurses. In addition, GPs are increasingly being asked to take on various tasks that previously have been done by clinicians in other organisation, with a recent personal study giving a figure of 27% of communications from secondary care providers to practices requiring one, two, or even three subsequent GP actions.
Somerset LMC has persistently told commissioners that this unfunded transfer of work cannot continue , and to support our case further we recently invited practices to take part in a survey to determine the nature and quantity of the non-commissioned tasks they were being asked to perform. The GPC released a document in January 2015 which reinforces the approach of Somerset LMC. (LINK)
Practices were asked to fill in and return a standard proforma asking about the nature and number of tasks that they did during January 2015 that were on behalf of other organisations, unfunded, and outside a GMS or ES contract.
Results
14 Practices returned forms. Not all clinicians in all participating practices took part, but all areas of Somerset were covered. These results are therefore qualitative, and represent only a small proportion of the actual number of tasks expected of GPs in the month under consideration.
The results were categorised as follows:-
| Blood test on behalf of another organisation | 52 |
| Med Cert that should have been dealt with elsewhere | 5 |
| Request for out-patient urgent prescription | 19 |
| Letter requesting GP follow up investigations done elsewhere | 21 |
| Inappropriate re-referral request | 27 |
| Other | 53 |
| TOTAL | 117 |
There were many additional comments made (see attached list). These relate mainly to the category ‘other’ and they reveal work not counted above, which when added to the total adds up to a final total of 198 such tasks. This is an average of 14 per Practice.
The LMC evaluated the category ‘other’ and classified the requests into broad groups and the results are as follows:-
| Re or onward referral for related condition | 20 |
| Follow up investigations done elsewhere | 17 |
| Prescriptions that should have been done elsewhere | 12 |
| Blood test request | 11 |
| Pre and post op care | 8 |
| Miscellaneous | 8 |
| Admin tasks | 7 |
| ECG requests | 6 |
| Pharmacy referral | 2 |
| Dental | 1 |
| Examination Board letter | 1 |
Discussion
The fact that only 14 out of 75 Practices returned forms is most likely a reflection of workload pressures rather than a feeling that this matter is not important to GPs . For the same reason there is a degree of under reporting for those Practices that did return forms. We are very grateful to those GPs who managed to contribute.
That said, we do now have a snap shot of the nature of the work transferred and an idea about the proportion of practice work that they may represent. What is most striking about the figures is that most of the requests under ‘other’ are related to tasks that clearly remain under the contractual remit of the other organisation, e.g. onward referrals for related conditions, follow up of investigations and prescribing. This is supported by the initial results table which also demonstrates that by far the largest transfer of work is phlebotomy.
Suggested Next Steps
The Commissioners need to work with the LMC to ensure that other organisations fulfil their contractual obligations
To facilitate this Somerset LMC would suggest that Practices use the attached proformas – based on those suggested by the GPC - to send back inappropriate requests to the submitting organisation, whenever this is practical and not detrimental to the patient. You may choose to use the form to inform the organisation that the practice has complete the task requested on this occasion, but will not do so in the future.
The LMC and CCG have already started to negotiate on developing a new form of ES to address the funding of transferred work and we hope that this document will help with that development
