Practices normally do not have capacity to undertake work passed to general practice from outside agencies. This may include non-contractual work coming from secondary care that is not resourced. For example, undertaking blood tests, making referrals for diagnostic investigations, or onward referrals on behalf of secondary care providers.

Practices have no contractual obligation to undertake this work and should pass requests back to the provider. We have produced a pack of template letters for this purpose. Many practices already have protocols in place to do this.

On clinical preview of documents, GPs can highlight inappropriate work for the practice to undertake. Non-clinical staff can then use template letters to pass the work back. It is important that any protocols do not result in increased workloads.  

These actions will likely help deter local systems from passing on work that is not properly resourced. Raising instances where this has happened in LMC liaison meetings with local trusts/ICS will likely also help. If local systems fail to change their practices in relation to work that is not resourced, general practices should escalate the issue to national teams.

For a salaried GP external un-resourced workload is work which takes them over their contracted hours. This needs to be measured and then discussed with the employer so that work demands of the salaried GP can be delegated to others, prioritised such that when contract hours are delivered any remaining demands for work are handed back to the practice to manage.

In the longer term, careful job planning can be used as a tool to identify which of the various demands on a salaried doctor’s time are prioritised for delivery within the contracted hours, or a new contract with increased hours and remuneration can be agreed if both parties wish.

Job planning process are illustrated clearly in our BMA GP retention webinar.