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‘Escalation routes’ should be set up after 25 daily GP contacts, says BMA guidance

by Anna Colivicchi
15 May 2023

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ICBs should ensure there are ‘formal escalation routes’ in place for GPs after 25 daily clinical contacts, with escalation plans agreed by practices, the BMA has said in new guidance.

From this week (15 May), GP practices are contractually required to offer an ‘appropriate response’ to patients the first time they get in contact, by offering them an appointment or redirection, rather than asking them to call back at a different time.

While GP leaders warned this would lead to increased pressure on NHS 111 and A&E, NHS England attempted to clarify in the recovery plan that GPs should only redirect patients in ‘exceptional circumstances’. It also said practices should inform their ICB on each such occasion.

However, conflicting BMA guidance has now been published, warning that practices attempting to adhere to the new requirement ‘may do so at the expense of clinician wellbeing and patient safety’.

It reiterates the GP Committee for England’s (GPCE) safe working guidance recommending that clinicians have no more than 25 clinical contacts per day because anything beyond this ‘can lead to decision fatigue, clinical errors and patient harm, and clinician burn out’.

The guidance said: ‘GPCE thus advises practices to protect patients and clinical staff from these risks by limiting clinical contacts to no more than 25 per day for each GP, and any excess demand beyond this being signposted to other settings such as 111, overflow hubs, or urgent treatment centres.

It argued that this is ‘permitted within the contract which says that patients should be offered assessment of need or be signposted to an appropriate service’.

And it added: ‘ICBs should ensure that there is a formal escalation route for practices that have reached safe capacity. Operational Pressures Escalation Level (OPEL) measurement should be used, and escalation plans should be agreed by practices, LMCs, and ICBs to enable safe onward signposting of patients.’

NHS England has not returned a request for clarification of what counts as an ‘exceptional circumstance’ and whether practices following BMA guidance will be in breach of contract or not. BMA also did not comment by the time of publication.

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