The BMA's Quality first: Managing workload to deliver safe patient care guidance advises that practices look at their workload to see what can be refused in order to free up time for practices.
Non-compulsory, non-NHS work, not falling under collaborative arrangements may be declined, when appropriate. This would include:
- private sick notes – employers should accept statutory self-certification to cover the first seven days of absence
- occupational health vaccinations and reports (most commonly Hepatitis B). See BMA guidance on this.
- requests for work related to research studies
- passport application countersignature - this can be done by a range of non-medical professionals
- insurance medical examinations, that can be carried out by an independent clinician
- blanket certification for school absence for minor illnesses that do not require a GP appointment. However practices need to be aware that there will be exceptions to this in specific circumstances (for instance when there could be a safeguarding issue)
- blanket requests to certify fitness to exercise, whether for local authority or private gymnasia or for any other activity, including travel. (Requests for a medical opinion on fitness are invariably inappropriate as GPs are not in a position to provide one; a simple statement of fact related to medical condition would be appropriate if the practice is happy to provide the service)
The BMA says that other service provision that falls under collaborative arrangements can be declined where it is not essential for a patient’s registered GP specifically to carry out the work unremunerated.
This could include:
- requests for letters or reports regarding re-housing and ‘Blue Badge’ applications, where local authorities should have systems to assess applications from information provided directly by patients.
- requests to supply patients with letters in support of benefit appeals, which is beyond the normal statutory processes to request medical information. Such informal information often does not carry weight, and takes up inappropriate GP and staff time. Link to LMC DWP appeals letter
- confirmation of identity and/or witness to signature, when this can be done by another non-medical professional
- assessment of mental capacity when it would be appropriate for another clinician to provide the service, recognising that in some circumstances it will be appropriate for the GP to do this
- Some extra-contractual work for which a fee is payable, such as Personal Medical Attendant reports for insurance purposes, and Criminal Injuries Compensation Board reports would be difficult or inappropriate for providers other than registered GPs to provide. The BMA says that practices are unlikely to find it is appropriate to stop providing such work, however many practices now provide computer generated reports that fulfil the requests from insurance companies. Whilst this can save time, care should still be taken to ensure the report produced is accurate and appropriate.
How to refuse such work
The BMA toolkit has 11 template letters for inappropriate requests to general practice, very helpfully these have been set up in the different clinical systems so you can import them directly into your clinical system.
The templates cover the following areas:
- secondary care work transfer
- inappropriate prescribing requests
- requests to follow up investigations performed in other settings
- requests for post-operative checks
- discharge of patients after missed appointment
- letter to local CCG regarding discharge of patients after missed appointment
- inappropriate workload transfer
- letter for request to complete non-contractual administrative task
- response to requests for work absence sick notes for less than seven days
- letter to area team regarding delay to information request or payment
- letter to hospital provider regarding follow up of diagnostic test results following a patient’s discharge from hospital
- letter to CCG in response to requests to follow up investigations performed in other settings and diagnostic test results following a patient’s discharge from hospital
Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member
- The BMA’s Quality first: Managing workload to deliver safe patient care and its associated online resources.
- The NHS Alliance report Making Time in General Practice
- NHS England’s Releasing Capacity in general practice initiative, with its ‘10 high impact actions’