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Overwhelmed GP practices to divert patients in ICB pilot scheme

by Anna Colivicchi
3 June 2024

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An ICB has agreed to allow GP practices overwhelmed with demand to close and divert patients if they declare an operational pressures escalation level (OPEL) black alert.

Kent and Medway ICB will soon begin a pilot of the response framework, developed with Kent LMC, which allows practices to self-declare their OPEL status based on their workload.

Kent LMC said the ICB is looking for a number of practices to volunteer to take part as a first step.

Under the system:

  • Practices declaring OPEL 4 – which is characterised by ‘significant staffing clinical gaps’, inability to cope, ‘significant estate issues’ and ‘need to cancel some booked appointments’ – would receive support from the ICB to close ‘if required’ as well as diverting patients elsewhere.
  • For practices declaring OPEL 3 – meaning they are ‘busier than usual’, ‘struggling to cope’ and experience ‘increased’ unplanned activity – the ICB would ‘facilitate potential mutual aid of additional staff’ from other providers as well as ‘redirection of calls’ and liaise with trust to support referrals for same-day urgent care.
  • OPEL 2 practices – ‘busier than usual but coping’ – would be supported by the ICB to access clinical teams to support onward referral, and the ICB would also perform a review of NHS 111 referrals.  
  • Practices operating ‘as usual’ with no additional pressures would report an OPEL 1 alert level, with no action taken.

In a bulletin, Kent LMC told local practices: ‘The ICB would like to pilot this with a few practices across each health and care partnership area.

‘This is not contractual and is not in any way intended to support or inform any sort of performance management.’

The LMC added that any practice that agrees to be one of the pilot sites will have the option to withdraw ‘if they feel this is not supportive in the way intended’.

‘We appreciate how pressured practices are, and it is not intended that this should add to practice workload but hopefully to provide help,’ it added.

Actions for practices declaring OPEL 4  

Source: Kent LMC

A spokesperson for Kent and Medway ICB said: ‘We are planning on launching a pilot for a primary care alert system soon. This will enable safe, high-quality patient care to continue during additional periods of pressure.’

Kent LMC stressed the trial is separate from General Practice Alert State (GPAS), through which practices around the country have been declaring increasing pressures weekly using ‘green’, ‘amber’, ‘red’ or ‘black’ status, but which GPs have criticised as being of ‘very little value’.

Devon LMC, which pioneered GPAS, agreed a pilot with the ICS to assess how to respond when practices are under ‘severe’, ‘extreme’ or ‘intolerable’ pressure.

Measures considered in Devon included suspension of routine appointments and reviews, a shift to telephone triage, remote consultations for most primary care, suspension of non-core work and QOF and closure of some practices with care delivered through additional capacity at shared hubs.

Last year, it was revealed that NHS England is working towards incorporating general practice in the ‘OPEL’ system pressures framework although it has made no further updates on the plans.

The RCGP has also called for a patient safety alert system to be introduced in general practice, asking for practices to be supported with overflow hubs and additional locums.

A version of this story first appeared on our sister publication Pulse.