GPs will, from next month, be contractually obliged to offer a response to patients the first time they get in contact, which will include ‘communicating with the patient’ or directing them to appropriate services.
The changes to the regulations regarding access were laid before parliament on 18 April, and will come into force on 15 May.
Following the imposition by NHS England last month, the GP contract has been changed to say that ‘an appropriate response’ must be provided to patients the first time they contact the practice, and defines that response as having to:
- ‘invite the patient for an appointment, either to attend the contractor’s practice premises or to participate in a telephone or video consultation, at a time which is appropriate and reasonable having regard to all the circumstances;
- provide appropriate advice or care to the patient by another method;
- invite the patient to make use of, or direct the patient towards, appropriate services which are available to the patient, including services which the patient may access themselves; or
- communicate with the patient— to request further information; or as to when and how the patient will receive further information on the services that may be provided to them, having regard to the urgency of their clinical needs and other relevant circumstances.’
The regulations also include a clause 4 that the response must ‘where appropriate, take into account the preferences of the patient’ and must ‘not jeopardise the patient’s health.’ (see box below)
An LMC has now warned that the changes around access and in particular clause 4 will result in GPs diverting ‘extremely large numbers of patients’ to 111 and A&E for fear of being held in contract breach’.
New guidance distributed to practices under Berkshire, Buckinghamshire and Oxfordshire LMCs highlighted that the meaning of clause 4 is ‘unclear’, ‘illogical’ and ‘essentially useless’, and will cause confusion around what represents a breach of contract.
The LMC’s guidance published yesterday and seen by our sister publication Pulse said: ‘This is an illogical clause which is so broad in its definition as to be essentially useless. As “jeopardise” is not defined, nor is what aspect of the patient’s “health” then it is questionable how it should be interpreted.
‘Obviously, if a response is “appropriate” it would not “jeopardise the patient’s health” – the clause makes no sense.
It added: ‘Taken literally this clause forces the practice to direct the patient to another service…in the interests of patient safety if the practice is not able to meet the patient’s needs that day, or if it is not possible to guarantee their health will not be “jeopardised” by delaying their consultation/request to a later date.
‘This clause will likely result in practices diverting extremely large numbers of patients to 111 and A&E for fear of being held in contract breach, due to the unclear meaning of this clause.’
The LMC said it had been contacted by practices asking for advice on the implications of the contract imposition in the context of ‘increasing demand and diminished workforce.’
The BMA expressed concerns around the new requirements on access, saying it believes it ‘is not achievable for many practices with current resource and workforce.’
It has has also published new guidance on care navigation and triage, in order to help GPs signpost patients appropriately either within the practice or elsewhere.
The contract changes in full
The NHS (General Medical Services Contracts and Personal Medical Services Agreements) (Amendment) Regulations 2023 says:
Contact with the practice
(1) The contractor must take steps to ensure that a patient who contacts the contractor—
(a) by attendance at the contractor’s practice premises;
(b) by telephone;
(c) through the practice’s online consultation system; or
(d) through any other available online system,
is provided with an appropriate response in accordance with the following sub-paragraphs.
(2) The appropriate response is that the contractor must—
(a) invite the patient for an appointment, either to attend the contractor’s practice premises or to participate in a telephone or video consultation, at a time which is appropriate and reasonable having regard to all the circumstances;
(b) provide appropriate advice or care to the patient by another method;
(c) invite the patient to make use of, or direct the patient towards, appropriate services which are available to the patient, including services which the patient may access themselves; or
(d) communicate with the patient—
(i) to request further information; or
(ii) as to when and how the patient will receive further information on the services that may be provided to them, having regard to the urgency of their clinical needs and other relevant circumstances.
(3) The appropriate response must be provided—
(a) if the contact under sub-paragraph (1) is made outside core hours, during the following core hours;
(b) in any other case, during the day on which the core hours fall.
(4) The appropriate response must—
(a) not jeopardise the patient’s health;
(b) be based on the clinical needs of the patient; and
(c) where appropriate, take into account the preferences of the patient.
A version of this article was previously published on our sister title Pulse
- Practice managers and GPs will be able to hear the latest on all the important changes to the GP contract for 2023/24 at this year’s Management in Practice event in Birmingham. Register here for free.
