While many of these tasks have historically been absorbed by general practice to support continuity of care, the volume of these requests has now reached a point where they account for an estimated 25–30% of GP daily workload. This has had a direct impact on the availability of appointments and access for patients needing core GP services.
Dr Robert Westgate, a Carlisle GP and Chair of the North Cumbria Local Medical Committee, said:
“We’ve seen a significant increase in work passed from other parts of the health system to GPs, including prescriptions, referrals and test follow-ups that fall outside the scope of our contracts. This is something we now need to address, not to pass on responsibility, but to ensure that general practice can remain safe, available and sustainable for the future.
These changes will ensure patients still receive the care they need—often more directly from the specialist service managing their condition. We will continue to work constructively with our colleagues across health and care settings to support patients appropriately.”
Patients are asked not to contact their GP practice about these changes. Practices will provide information directly to those affected and will continue to support patients in navigating the updated pathways.
As a result from August 2025, patients may be directed back to the hospital or specialist service responsible for their care, particularly where requests fall outside of the core, contracted responsibilities of GP practices. This change does not affect a wide range of enhanced services that general practices will continue to provide, such as DMARD monitoring under shared care agreements (e.g. methotrexate) , hormone injections (e.g. Zoladex), vaccinations and immunisations, NHS health checks, learning disability reviews, INR monitoring, minor injuries treatment, sexual health services and others.
The move follows the decision of some GP surgeries to serve notice on a local 'secondary care workload agreement', which had temporarily allowed general practice to support hospital services with specific tasks. Work is now underway with the NHS North East and North Cumbria Integrated Care Board (ICB), alongside North Cumbria Integrated Care NHS Foundation Trust (NCIC) and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW), to ensure that appropriate alternative arrangements are in place from August 2025.
Tasks previously carried out under the agreement included ECG and physical health monitoring for people prescribed specialist mental health medication, pre-operative and post-operative blood test, post-operative wound care, chemotherapy-related blood testing, and blood monitoring for specialist biological therapies.
