Practices need plans in place to ‘proactively’ communicate with patients about any changes of services should the BMA’s proposed GP industrial action go ahead from August 1, NHS England has said.
This is to ensure ‘safe contintuity of care’, it added.
NHS England has said it will also provide a communications toolkit for ICBs to use, so patients are informed about the collective action and given ‘clear instructions on how they can continue to access services’.
The toolkit will provide ‘national messaging’ although ICBs will be have to adapt information to reflect local arrangements.
The details have been set out in an NHS England letter sent to ICBs and trusts instructing them to draw up wider plans to mitigate against the affects of collective action taken by practices.
It said that while it hopes action will be averted, ‘it is important we plan for all contingencies to keep patients safe – as we have in other periods of industrial action. We are committed to having arrangements in place that manage the impacts in a reasonable worst-case scenario’.
The BMA has updated the menu of actions it says practices can choose from as they see fit (see box below). None of the measures place GPs in breach of their contracts, it has said.
However, ICBs have been tasked with taking a ‘whole system view of potential impacts and risks to patients’ that collective action could lead to, and have been given the deadline of 30 July for submitting a written ‘self-assessment of readiness’.
They should put in place ‘proportionate incident management arrangements’ for August given the uncertainty of the full impact of collective action, the letter signed by NHS England’s national director of primary care, Dr Amanda Doyle, and its national director for NHS resilience, Mike Prentice, explained.
And the letter asks that planning takes into account:
- the secondary impacts and consequences which may occur – such as potential pressure/congestion on urgent and emergency care, elective and discharge pathways (if primary care access is reduced).
- affect on mental health and community pathways (such as mental health crisis teams, urgent community response, children and young people’s services, midwifery, intermediate care, falls prevention, and Enhanced Health in Care Homes services).
- short, medium, and longer-term changes to patient flows between and across primary care, 999, 111, and urgent treatment centres/minor injury units.
- any potential impacts on diagnostic and elective activity.
‘As in other disputes, maintaining services for patients with urgent needs, such as those with deteriorating conditions, meeting urgent diagnostic requirements, and ensuring timely triage to essential services will be key’, the letter said.
NHS England also advised that despite the BMA saying collective action won’t breach the GP contract, ‘commissioners may need to seek assurance from participating practices that national and local contractual requirements continue to be met’.
Finally, the letter, said there ‘there should be open lines of communication with local GP practices and Local Medical Committees to ensure ICBs are made aware of any proposed service changes in a timely manner’.
Meanwhile, practice manager and other non-GP partners are being encouraged to show their support for the BMA’s proposed GP industrial action, but only have a few days left to do so.
Their views are being sought alongside the non-statutory ballot currently being held by the BMA’s GP Committee (GPC) England. This asks GPs to vote on whether they are prepared to undertake different forms of collective action within their practice and closes on 29 July.
Although practice manager and other clinical partners such are not eligible to participate in the ballot itself, their views are still on the proposed action and the BMA’s campaign Protect your patients, protect your GP practice via this form.
The non-statutory ballot follows a referendum by GPC England that found that 99% of GPs did not agree with the recent contract imposition, as well as the committee officially declaring a ‘dispute’ with NHS England.
Nine actions for practices can take as suggested by the BMA
- Limit daily patient contacts per clinician to the recommended safe maximum of 25. Divert patients to local urgent care settings once daily maximum capacity has been reached.
- Stop engaging with the e-Referral Advice & Guidance pathway – unless it is a timely and clinically helpful process for you in your professional role.
- Serve notice on any voluntary services currently undertaken that plug local commissioning gaps.
- Stop rationing referrals, investigations, and admissions. Refer, investigate or admit your patient for specialist care when it is clinically appropriate to do so. Refer via eRS for two week wait appointments but outside of that write a professional referral letter where this is preferable. It is not contractual to use a local referral form/proforma – quote our guidance and sample wording.
- Switch off GP Connect functionality to permit the entry of coding into the GP clinical record by third-party providers.
- Withdraw permission for data sharing agreements that exclusively use data for secondary purposes (i.e. not direct care)
- Freeze sign-up to any new data sharing agreements or local system data sharing platforms.
- Switch off Medicines Optimisation Software embedded by the local ICB for the purposes of system financial savings and/or rationing, rather than the clinical benefit of your patients
- Practices should defer signing declarations of completion for ‘better digital telephony’ and ‘simpler online requests’ until further GPC England guidance. So, do not agree yet to share your call volume data metrics with NHS England and do not agree yet to keep your online triage tools on throughout core practice opening hours, even when you have reached your maximum safe capacity.
Source: BMA
Additional reporting by Joanna Robertson.
Part of this story was first published on our sister title The Pharmacist
