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Changes to access to GP services have not yet come into effect, says BMA

by Anna Colivicchi
17 April 2023

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GPs are not yet contractually obliged to offer a response to patients the first time they get in contact, the BMA has confirmed.

The union said that the new requirement for GPs to offer a response to patients the first time they get in touch with their practice will not come into effect until signed off by Parliament.  

Our sister publication Pulse understands that the publishing of the new access requirement regulations is imminent, and the contract will be updated to make clear that patients ‘should be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice’ after NHS England imposed changes last month.

The BMA expressed concerns around the new requirement, saying it believes it ‘is not achievable for many practices with current resource and workforce.’

And at the end of last month, GP Committee England made clear that the new contractual ban on asking patients to call back at a different time will not mean having to offer them an appointment on first contact.

Now, in an update to practices, Dr Kieran Sharrock, GPC England acting chair, confirmed that the changes will not come into effect until laid before Parliament.

He said: ‘Note that changes on access to general practice services have not been laid before Parliament and ICBs will therefore not have sent contract variations to practices.

‘This means the changes have not yet come into effect. We will share further information on this imposed contractual change as soon as it is available.’

Meanwhile, the BMA has also published new guidance on care navigation and triage, in order to help GPs signpost patients appropriately either within the practice or elsewhere (see box).

While the union said there is ‘no standardised system for care navigation or triage in general practice’, it has offered tools to ‘support practices to implement a system that can be adapted to a practice’s individual circumstances.’ The guidance sets out the benefits of implementing a triage system, includes examples of triage flowcharts and covers steps for GP practices to take to make triage work for both clinicians and patients.

The guidance said: ‘Ensuring that patients are seen by the appropriate clinician in the right place and at the right time, supports good patient care and experience, reduces pressure on GP practices and allows GPs to spend their time where it is needed the most.

‘Care navigation and clinical triage allow practices to prioritise patients with the most urgent health needs, ensure they see the most appropriate clinician or are signposted to alternative services.’

How to make practice triage systems work for clinicians

The BMA guidance recommends that practices should: 

  • Ensure staff have enough time in their working day, so that they can assist patients in completing triage forms.
  • Ensure high-quality information is collected. A good medical history is key, and practices should ensure that triage forms allow patients to clearly describe their symptoms or conditions.
  • Consider staffing capacity. Practices should consider whether any additional staffing is required to effectively carry out care navigation/triage and how to mitigate workforce shortages.
  • Ensure an even distribution of practice workload. Tasks should be appropriately assigned to ensure staff are not overburdened.
  • Engage all staff in the process. Communicating with all practice staff is crucial to discuss responsibilities, impact on practice workload, and reorganisation of tasks. Practices should consider the staff skills needed to deliver triage effectively.
  • Introduce a clear and easy-to-follow triage flowchart. This is so that staff can distinguish between urgent and routine issues. Please see the examples we have provided.
  • Provide staff training. This is so that care navigators feel confident in using the system. Care navigators should not be expected to make clinical decisions, but the aim is to empower them to book patients into the appropriate appointment slots. Staff training should include formal training on managing difficult conversations with patients. Guidelines such as those published by Medics for Life could be used to support decision making.
  • Create a standardised script. This is for care navigators to follow.
  • Consider resourcing. Thought should be given to investment in additional resources, (e.g. equipment, hardware, software) that may be needed.

A version of this story was first published on our sister title Pulse.