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NEWS: How practices have taken on out-patient work

by in COVID-19, News

GPs have taken on a significant amount of secondary care work during the pandemic – partly because hospital services were ill-equipped for remote working, according to a new survey.

This includes performing blood tests for hospital out-patients and prescribing medication that would normally be prescribed in secondary care. Practices have also organised significant testing of patients before making referrals for cancer care, according to the British Medical Association.

The BMA said hospital staff lacked the digital resources for much of this work – and there had also been a failure to plan for delivering alternatives to hospital-based care in the community. Its latest survey of doctors found that half of GPs said they were providing care normally provided in hospital settings. Some 81% said they had been asked to undertake investigations and manage continuing care for patients who would normally be treated through out-patient settings. 80% of GPs said practices were still short of face masks for staff and 69% said they needed stocks of face-coverings for patients.

One GP in North London referred to “letters stating that ‘due to the current situation’ they don’t want the patient to attend their hospital for blood tests, ‘please can you organise these blood tests in the community’, adding: “We have never had a commissioned community phlebotomy service and we certainly don’t have one now. Our patients have to attend hospital for blood tests, so we have to write to them to explain and again, it takes time to do this.”

Dr Richard Vautrey, chair of the BMA’s GP committee, said: “This crisis has truly shone a light on the lack of robust IT systems across the health service and the tsunami of extra work increasingly placed on GPs as a result. This needs rapid action to deliver long-term solutions to improve the interface between secondary and primary care, and make sure we have the digital infrastructure in place to stop unnecessary prescribing, duplication of workload and extending patient pathways.”

He added: “Crucially though, we need to trust GPs as clinical leaders and give them and their teams the greater autonomy they’ve been afforded during this pandemic to bring patient care into the twenty-first century, where video consultations, for example, are readily available and red tape limiting change is dramatically reduced.”

* The Royal College of GPs is pressing for more advice on what practices should tell shielding patients who have been told to return to work. Shielding is to end in August and those shielding advised to return to work.

College chair Professor Martin Marshall said: “GPs have been at the forefront of identifying patients who have been shielding and answering their questions about the rules. We will remain the first port of call for patients concerned about their health and we anticipate many patients will approach their GP worried about how the process will change and how it will impact on them.”

He added: “We need to be absolutely clear about the information and advice we can give them. The College recently wrote to the Secretary of State for the Department of Work and Pensions, calling for clarity around the working rights for those who have been advised to shield. This is something our members report patients asking them about, given that shielding patients are not necessarily sick and therefore not entitled to fit notes. It is vital that GPs and other healthcare professionals are given as much clear information as possible on such issues surrounding shielding and about the safety and practicalities of any changes to the guidance, so that we can advise appropriately and hopefully alleviate any concerns.”

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