Many GP practices ‘will not achieve’ the new contractual requirement to offer a response to patients the first time they get in contact, new guidance from the BMA GP Committee England has warned.
The GP 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, triggering potential industrial action.
Now the union has published detailed guidance on the new requirement, saying it believes it ‘is not achievable for many practices with current resource and workforce.’
The BMA guidance, published last week, said: ‘Though we may agree with the aspiration of this amended regulation, GPCE believes that this requirement is not achievable for many practices with current resource and workforce.
‘With GPs numbers decreasing, consultation numbers higher than ever, and general practice being under-resourced, we think this government-imposed contract will push GPs and practices to the brink of their existence, within the NHS. For this and other reasons GPCE rejected the contract changes.’
The contract will be updated to say that the decision regarding providing an appointment or to signpost must ‘be based on the clinical needs of the patient’, but the BMA warned that many practices will struggle to provide this.
It said: ‘Some practices may be able to achieve this requirement as a function of having adequate care navigation capacity or by utilising total-triage systems, however, many practices will not be able to do this as demand outstrips capacity.
‘Many practices do not have enough adequately trained care navigators or other clinicians to make this assessment of clinical need.’
The GPCE sees the use of care navigation ‘as a potential solution’ to this imposed contract stipulation, but practices ‘may have other innovative ways of managing this issue’, such as total triage.
However, the BMA do not advocate a move back to duty doctor or other systems which place an ‘unnecessary and unsafe burden’ on GPs.
Practices where care navigation is used to allocate patients to ‘appropriate services’ have various possible dispositions for patients who contact the practice, according to the guidance:
- offer on-the-day assessment by another clinician for cases perceived to be urgent
- offer assessment at another time by a clinician for cases relating to longer-term and non-urgent conditions
- signpost to another service where another service is appropriate e.g. mental health support, community services, community pharmacy
- signpost to 111, UTC, overflow hub when capacity in the practice is reached
- Request further information – for example via digital tools available to surgeries.