Practice PPGs are a crucial ally and resource for practices. GPC England encourages practices to engage their PPGs and to openly discuss the challenges and pressures facing general practices both in general and locally.

It is important to consult PPGs and look for their support for any changes that you are considering. GMS regulations allow practices to provide "services delivered in the manner determined by the contractor's practice in discussion with the patient". PPGs are an important means for communicating these changes and the reasons for them to the wider patient population.

PPGs may also be able to help practices in the relations with ICBs by directly lobbying them and by demonstrating the practice’s patient engagement. They can also give crucial insight into the needs and priorities of the patient population. 

The 2020 General Practice Workload Capacity Audit from Beds, Herts and Cambs LMCs revealed that 95% of practices reported additional requests from acute trusts, with an average practice of 10,000 list size spending the equivalent of a day a week dealing with such requests.

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 the burden of increased workload. These actions will likely help deter local and regional systems from passing on work that is not properly resourced.

Raising instances where this has happened in primary/secondary interface meetings, and LMC liaison meetings with local trusts/ICS will 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.

Practices should link in with their LMCs to communicate themes and patterns from hospital workload transfer. LMCs should consider the use of OPEL and SITREP as a way of collating workload and workforce pressures, as well as recognising areas and times of distress. This can help outline the case for further investment or deployment of resource in general practice and primary care.

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 processes are illustrated clearly in our BMA GP retention webinar.