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Recommendations

There are a series of recommendations arising from this report, with the top five areas listed below.  We have targeted recommendations at three different audiences.  First, NHS England who commissioned this report and have a key role for setting the national context.  Some things can only be sorted out at the national level. Second, we see that there is a pressing need for a shared local commitment from commissioners (CCGs supported by their CSU and Local Authorities), local hospitals, community services and practices to work together to fix the obstacles that patients and clinicians encounter every day. Finally, we have a series of recommendations for individual practices, or practices working together in groups, identifying how they could learn from each other about factors which are within their own control for reducing their workload. In each case we have highlighted one or two recommendations that could have an immediate impact on reducing workload.

Reducing the bureaucracy in general practice must be a national priority

NHS England needs to take the lead in reducing unnecessary bureaucracy in general practice.  Practice managers identify the problems with getting paid as the single biggest burden on their time and problems have got worse in the last two years following all the organisational changes.  Sorting out the range of problems identified by practices and listed in this report should be an urgent priority for NHS England.

Immediate practical steps in this area include:

  • NHS England must ensure that it rapidly sorts out the way practices are paid working with its new provider of primary care support services and with HSCIC who are responsible for GPES and CQRS, with regular feedback from practices to monitor progress.
  • NHS England should urgently review the range of safety notices that are sent to a practice (from all sources) and consider how filtering might be improved so that practices receive those that are relevant to them without the confusion of irrelevant notices.

Practices should work together to free up time

There are many reasons for individual practices to start working together but we think there is a strong case simply on the basis of freeing up time in general practice.  Practices working together in localities, federations, or as part of developing new models of care through Vanguards and the Prime Ministers Challenge Fund, are all exploring how they can save time through sharing tasks and responsibilities. We make clear recommendations about specific steps that could be taken in this area.

Immediate practical steps in this area include:

  • Funds should be made available to all practices to free up time for GPs and other leaders in the practice to think through how they can work differently, learning the lessons from the PM’s Challenge Fund sites and the Vanguard sites as they become available – creating the ‘headroom’ needed to plan new ways of working and clinical innovation.

Communication between general practice and hospitals is crucial

One of the strongest themes coming out of our research is the unnecessary extra workload created by the lack of clear systems and processes for practices and their local hospitals to communicate with each other and their shared patients. Some of this can be addressed through consistent national rules and guidelines, but probably even more important, is a shared local commitment and creating opportunities for clinicians to cut through all the unnecessary rules that get in the way of rapid and effective treatment of patients and lead to so many repeat consultations to chase up basic administrative tasks.

Immediate practical steps in this area include:

  • Patients who don’t attend a hospital appointment should have the right to rebook within two weeks without going back to the GP
  • Commissioners should require providers across the Country to develop a local system for allowing GPs to discuss a case with a specialist and for hospital clinicians to speak direct to a GP, within hours not days.
  • Discharge letters should be transferred electronically to the practice, data should be
  • structured and presented in a consistent way and should normally be produced within 24 hours of discharge.

Unlocking the potential for the whole system to work together

Many of the problems encountered by practices link to difficulties faced by other partners across the local health and social care system and the wider community. Although our remit was to explore ways of reducing the pressure on general practice, many of the solutions lie in the way that all services involved in caring for patients work together. There are also substantial opportunities for practices to share their workload with other partners across the local community.  Building opportunities for prescribing for health and trusting other agencies, often better at addressing many of the health needs that we face, offers the potential to both reduce workload within practices and increase confidence across the wider community. This heading also includes a wide range of recommendations for improving IT systems that would enable partners across the health system to work so much more effectively together and share information with patients.

Immediate practical steps in this area include:

  • Federations should be funded to work across their practices to build practical social prescribing projects that offer real alternatives to taking up the GP’s time with patients whose needs can be better met by other kinds of support in the wider community
  • Work actively to support interoperability between systems providing records in primary care and those in secondary care, working with system providers.
  • Commissioners need to work with their local providers to align incentives, removing the barriers for working together across a local area – including financial incentives that cut across effective collaboration.

Changes within individual practices

Finally, there are steps that individual practices can make to reduce their workload but these will vary for each practice. These include extending and building the practice team and ensuring that patients are, as far as is possible, reducing repeat appointments and developing the use of group consultations. Practices will need support in reviewing how they compare to others and understanding what the substantial variation across practices means for them, and in identifying what they might do to free up time. Again, we offer examples of good practice and specific recommendation, many of which may work best if carried out alongside other local practices.

Immediate practical steps in this area include:

  • NHS England should offer increased funding through national incentives for practices to employ a wider range of staff within the practice team, with the decision on the type of staff and how they used being left to local discretion.
  • Commissioners nationally and locally should give a high priority to supporting general practice to look at how they can free up GP time and work in new ways with partners across the healthcare system.
  • By working together, practices should highlight the opportunity to reduce potentially avoidable appointments through (for example) sharing the services of support staff or commissioning new services.

Taken together, this broader perspective, acknowledging the links and connections across the health care system and the wider community, offers a comprehensive approach to reducing workload for GPs and general practice, with the knock-on effect of reducing pressure on the system as a whole.