Choose which actions to take
GPC England is not recommending which action(s) practices take. It is for each practice to pick and choose as they see fit. You may decide to add to your choices over the days, weeks, and months ahead. This is a marathon, not a sprint.
Some of these actions can be permanent changes – professional, collective and a single opportunity to embrace sustainable and safe change. Others may be de-escalated following negotiations with the new Government.
We have also created template letters to help practices manage workload and limit capacity to deliver safe, high-quality care.
Limit daily patient consultations
Limit daily patient consultations per clinician to the UEMO recommended safe maximum of 25.
Divert patients to local urgent care settings once daily maximum capacity has been reached. We strongly advise consultations are offered face-to-face. This is better for patients and clinicians – read our patients first document available here.
Why are we doing this?
Safe working is integral to high quality patient care. Limiting your working day to 25 consultations is safe for patients and for doctors. Check out our updated safe working guidance handbook.
What is the impact of this?
Safer working practices mean GPs are less likely to burn out and leave general practice. This allows patients more time in the consulting room in a less pressured environment for GPs.
Serve notice on any voluntary service
Serve notice on any voluntary services currently undertaken that plug local commissioning gaps and stop supporting the system at the expense of your business and staff.
Why are we doing this?
This action highlights that practices cannot continue undertaking work that is un-resource and once funding is received for these services, they can be better delivered by the surgery team.
What is the impact of this?
Stopping undertaking un-resourced services allows practices to focus on delivering core services to their patients.
Withdraw permission for data sharing agreements
Withdraw permission for data sharing agreements that exclusively use data for secondary purposes (i.e. not direct care). Read our guidance on GP data sharing and GP data controllership. This action will have no impact on direct patient care, i.e. A&E departments or outpatient departments etc.
Why are we doing this?
With GPs as data controllers (link to focus on doc, ask DP?), there is an inherent risk where practices have multiple data sharing agreements; information governance breaches could occur without their knowledge and putting them at risk.
What is the impact of this?
Reviewing your data sharing agreements and ensuring these are appropriate can protect you from information governance breaches.
Freeze sign-up to any new data sharing agreements or local system data sharing platforms
Freeze sign-up to any new data sharing agreements or local system data sharing platforms. Read our guidance on GP data sharing and GP data controllership. This action will have no impact on direct patient care, i.e. A&E departments or outpatient departments etc.
Why are we doing this?
GPs are data controllers and signing up to new data sharing agreements can expose them to risks of data governance breaches.
What is the impact of this?
This will protect GPs from potential data governance breaches.
Stop engaging with the e-Referral Advice & Guidance (A&G) pathway
Unless it is a timely and clinically helpful process in your professional role.
Why are we doing this?
There may be instances where A&G works for you, however it can lead to lengthy back and forth discussions with further requests for GP actions. It is perfectly acceptable to send a referral letter to the relevant specialty and not use A&G. We have provided a focus on document on the use of referral tools, and a template response to send if your referral is rejected.
What is the impact of this?
This can free you up from needless bureaucracy and give you more time for patient care. You are not mandated to use A&G as stated in our guidance. If you encounter problems with this, we recommend contacting your LMC.
Stop rationing referrals, investigations, and admissions
- Refer, investigate or admit your patient for specialist care when it is clinically appropriate to do so
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Referrals via the 2-week pathway should still be adhered to
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Outside of urgent suspected cancer referrals (formerly two-week-wait), consider writing a professional referral letter rather than using a locally imposed proforma/referral form - these are not contractual - use and quote BMA guidance/sample wording.
Why are we doing this?
Completion of lengthy and complex proformas take up a lot of clinical time. There are no contractual obligations to complete these forms unless you feel it will benefit the patient and yourself. A professional well worded referral letter is adequate for this.
What is the impact of this?
This will reduce workload in general practice and free up GP time for patient care. It will also save time for the wider administrative team working in surgery.
Switch off GP Connect (Update Record) functionality
Switch off GP Connect (Update Record) functionality that permits the entry of coding into the GP clinical record by third-party providers. The majority of practices undertook this action during the summer 2024.
Why are we doing this?
GPs were concerned about third-party providers directly adding clinical diagnoses onto the patient medical record. An example could be a private healthcare provider adding a diagnosis to the GP record for which the GP then becomes responsible for ongoing care and prescribing. This could also potentially lead to endless entries to a less coherent medical record making it very difficult for the GP to focus on the problem(s) they are dealing with.
What is the impact of this?
The patient medical record remains clear and coherent and lines of clinical responsibility are maintained. This ensures more efficient and safe patient care in an easy-to-read medical record.
Switch off Medicines Optimisation Software
This is embedded by the local ICB for the purposes of system financial savings and/or rationing (rather than the clinical benefit of your patients). You should always act in your patient’s best interests and prescribe appropriately for the clinical presentation. Some areas may have local commissioned services for this software, and if you are unsure about this, contact your LMC.
Why are we doing this?
This software can often produce nuisance pop-ups on the screen during patient consultations. These pop-up suggestions may not always be in the patient’s best interest as they are often used for financial purposes.
What is the impact of this?
This will limit distractions to the GP during patient consultations and could ensure prescribing decisions are in the patient’s best interest.
Defer signing declarations of completion for “simpler online requests”
NHS England have said that online consultations should be available to patients every working day 08:00-18:30 during this contractual year, irrespective of practice pressures. We would advise you to defer signing up to this NHSE request so as to allow you to turn off online triage when you have reached your maximum safe capacity each working day. We will issue more guidance on this subject in early 2025 before contractual year end, so as to ensure any funding on offer is received.
Why are we doing this?
GPCE has significant concerns around online consultation software being available to patients for the duration of 08:00-18:30 given practices’ lack of capacity, and their responsibilities for ensuring patient safety. For many practices having online triage open for the whole day could lead to significant workload pressures that could adversely impact on patient care and clinicians.
What is the impact of this?
This provides workload control for practices who can be overwhelmed on a daily basis by online triage requests with limited ability to respond to patients in a timely fashion. Limiting contacts in a safe way will reduce stress on clinicians and limit the risk of burnout.