GPs in Northern Ireland have agreed a range of contingency measures to help address their spiralling workload and mitigate against the current crisis in primary care. The measures will include referring patients back to hospitals for test results and appointments, no longer arranging out-patient ambulance transport and no longer completing insurance or PIP paperwork. 

GPs will also use more telephone triage to make sure they only see patients who actually need to see a doctor and will encourage the use of over the counter medications. They may also choose to close their list to new patients and may introduce half day closing of practices.

Speaking about the decision, Dr Tom Black, chair of BMA’s Northern Ireland general practitioners committee said, “In the absence of a rescue plan for general practice, and to help address the ongoing crisis and as a response to funding cuts, we have had to take steps to withdraw some services, so that we can maintain our core service – seeing patients. 

"As a result, we are firstly advising GPs to cut back on unnecessary paperwork. This will include not dealing with patients who do not attend a hospital outpatient appointment, instead we will ask them to speak to the hospital directly to make a new appointment.

"We will also be advising patients that the hospital is responsible for notifying them of the results of any tests, investigations or treatment they had in hospital. We will no longer continue to organise patient transport for routine outpatient appointments.

"GP practices have to prioritise clinical work – actual time spent with patients - by withdrawing some services previously provided by practices. This will free up more GP time for direct patient care."

Dr Black added: "Many prescriptions are requested for items such as cough bottles, mouth washes, shampoos and sun creams all of which are available at the local pharmacist over the counter for a small charge. 

"By no longer providing prescriptions for these items it will free up a lot of time at practices and would make phone lines more accessible and mean a GP  has more time to see patients. GPs will encourage patients to buy these routine items from their pharmacist." NIGPC has been calling for the following rescue measures to prevent the collapse of general practice across the country: • Investment of 10% of the Northern Ireland healthcare budget on a safe, sustainable GP service for patients;  • Training and recruitment of more GPs so practices at risk of closure can stay open and meet the needs of patients • Reducing bureaucracy and improve IT systems so more time can be spent providing care to patients. 


Full list of service changes 


Hospital based services:
• GPs will no longer re-refer patients back to hospital clinics when they have failed to attend outpatient clinics or other hospital or trust based services. Patients will contact the hospital directly as they still hold the original referral letter from the GP.
• When a patient is in hospital or at outpatients and needs an onward referral for a non-urgent condition directly related to the complaint or condition which caused their original referral, onward referral to and treatment by another professional within the same provider is permitted and there is no need to refer back to the GP.
• Hospitals will organise the different steps in a care pathway promptly and will communicate clearly with the patients and GPs. This specifically includes a requirement for hospitals to notify patients of the results of investigations and treatments in an appropriate and cost – effective manner, for example, telephoning the patient.
• GP practices will no longer arrange for ambulance transport for routine outpatient clinics.

Paperwork: GP practices will now limit paperwork to free up more time to see patients:
• Forms for insurance reports and PIP reports may no longer be completed but copies of patient notes can be made available with the patients consent.
• GANFYDs (get a note from your doctor) - expect GP practices to refuse these requests or to make a charge. 

Consultations and prescriptions:
• GPs will try to delegate more tasks to other members of the primary care team such as nurses or pharmacists to try to free up more GP time for sick patients. 
• More consultations will take place over the phone or by IT rather than face to face in order to accommodate the increased demand for appointments.
• Many prescriptions for items such as cough bottles, mouth washes, shampoos and sun creams are available at the local pharmacist over the counter for a small charge. If patients did this for themselves it would free up a lot of time at practices and would make phone lines more accessible and free up GP time to see patients. GPs will encourage patients to buy these routine items from their pharmacist.  

List Closures:
Many practices are now working with a partner short of full complement such that they have more than 2,000 patients per WTE GP. This is an unsafe level of workload for many practices and one way of dealing with this is to close the practice list to new patients. 

Half day closing:
Some practices accommodate for the lack of GP staff by closing for a half day and this can improve the efficiency and effectiveness of the practice. 
 

For further information please contact:

BMA Northern Ireland, 16 Cromac Place, Cromac Wood, Ormeau Road, Belfast BT7 2JB
Telephone:
028 9026 9666   (switchboard)
028 9026 9672   (direct line)