Avon Local Medical Committee Secondary to Primary Care Work Shift Analysis

Survey Background Survey conducted in November 2015. Four weeks from Monday 2nd November to Friday 27th November Total surgeries responding was 77 out of 107, a 72% response rate. Total forms received was 2273. The results refer to NBT, UHB, WGH. We also have a category ‘Other’ for where the practices have not indicated which Trust has referred the work back to Primary Care. The form that was sent out to Primary Care, covered a number of categories. These included: Blood tests Other investigations e.g. arranging a scan Act on results of test and investigations Sort out problems arising from pre-op assessment Onward referral – from one speciality to another Onward referral – within the same discipline Prescribe medication Issue a sick note Apply for exceptional funding Other NBT North Bristol Trust; UHB University Hospitals Bristol; WGH Weston General Hospital “Other” includes private sector such as the Spire and the Nuffield. Also Emersons Green Treatment Centre run by Care UK.

The results show the total number of items referred back to primary care from all hospital trusts, NBT, UHB, WGH, in the month of November 2015. The total number of items referred back to Primary Care in November was 3,267.

Extrapolated annual figure would be 55,159 As the study took place over 4 weeks, numbers are multiplied by 13 to give an extrapolated annual figure (52 weeks) Figures are also extrapolated to give an estimated total had all 107 practices responded. This offers a comparison of what the results would have been if we had received a 100% response from our member Practices. Extrapolated total number of items passed back to primary care in November was 4243 Extrapolated annual figure would be 55,159

GP time was estimated at 10 minutes per item which we believe is realistic. However Exceptional funding takes considerably longer and is estimated at 30 minutes of GP time. These figures do not take into account nurse or administrative staff time, which is an additional burden on practices. Results show how much GP time was taken by work referred back to primary care from secondary care in the month of November 2015. Total minutes in November was 38,420. Each item referred back to primary care creates at least one appointment, which on average takes a GP 10 minutes to complete. Applying for exceptional funding can take up to 30 minutes to complete one application.

Please see slide 12 “Speculative data” where this figure is extrapolated to an estimated annual cost, and also an estimated annual cost had all107 practices in BNSSG taken part in the study. This shows an estimated total cost that all Trusts combined received in the month of November for work they have referred to Primary Care. The total overall payment received by all Trusts combined in November is £635,345.

NBT NBT North Bristol Trust (Southmead Hospital) Minutes Total minutes used by GPs for worked referred by NBT in November is 11,470. The total payments received by NBT for work they referred to Primary Care in November is £257,355.

UHB £ UHB University Hospitals Bristol Minutes Total minutes used by GPs for work referred by UHB in November is 8,350. Total payments received by UHB for work they referred to Primary Care in November is £203,028.

WGH £ WGH Weston General Hospital Minutes Total minutes used by GPs for work referred by WGH in November is 1830. Total payments received by WGH for work referred to Primary Care in November is £45,908.

Results where the Trust has not been Indicated £ Minutes Total minutes used by GPs for work referred to them by Secondary Care in November is 5,390. Total payments received by the Trusts for work they referred to Primary care in November is £142,032.

Speculative Data 53,361 Mins (889 hrs & 20 mins) Survey Recorded Dr time as 38,420 Mins (640 hrs & 20 mins) Had all surgeries responded, this could have been 53,361 Mins (889 hrs & 20 mins) Dr time costed at £75/hour £48,025.00 (£66,700.00) Annual Costs to Primary Care £624,325.00 (£867,100.00) This data can only be seen as speculative. Estimated at 10minutes of doctor time (Nurse and admin time excluded) for each piece of work passed back from Secondary care to Primary care. The data is further extrapolated to give 1. an estimated total had all practices participated (figures in brackets = £66,700) and 2. an estimated annual total from participating practices and estimated annual total had all practices participated (again – figures in brackets = £867,100)

Speculative Data Survey Recorded cost to Primary Care for Secondary care work done as £635,345.00 Had all surgeries responded, this could have been £882,423.61 Annual Costs to Primary Care £8,259,485.00 £11,471,506.00 This is speculative data and likely to be challenged by secondary care and probably by CCGs. It is an estimate of the tariff costs of activity passed from secondary to primary care, which is funded as part of secondary care activity but being passed by them back to primary care. We still think it is legitimate to cost it in this way. Once again, there are extrapolated figures to give an estimate of monthly costs had all practices contributed to the study, and extrapolated figures for annual costs.