Background to the changes
Following pressure from the BMA’s GP Committee concerning the need to address unfair shift of workload from secondary to primary care, a number of further changes were made to the NHS standard contract [which applies to all trusts] in January 2018.
These changes covered new requirements for hospitals, concerning things like issuing fit notes, responding to patient queries, making direct onward referrals and prescribing sufficient. They also covered shared-care arrangements and introduced new deadlines for clinic letters to be sent to GPs.
It is important to note that these conditions apply to all NHS providers like mental health trusts and community trusts – not just acute hospital trusts.
What progress has been made?
LMCs across the country have been working with CCGs and other providers to facilitate the implementation of this contract.
Trusts that don’t comply are in breach of contract so CCGs must act
Our LMC in Kent, for example, has published patient leafl ets and posters, which are being shared with local trusts to increase awareness among both patients and clinicians.
However, we know implementation of the NHS contract has been patchy.
It remains poor in some CCGs, while others have attempted to agree local variations. This causes understandable frustration for GPs and their teams, and it is something the BMA is eager to address.
How can GPs deal with hospitals that aren’t complying?
These changes are not optional – they are contractual requirements – so if providers are not complying, they are in breach of their contract, and CCGs must hold them to account. CCGs have the ability to act on such breaches by taking remedial action that could include financial sanctions.
However, practices are also key to ensuring these rules are abided by, and it is vital that GPs and their teams push back on inappropriate demands by reporting breaches to the CCG and provider, rather than allow them to continue unchallenged.
Last year, the BMA produced a number of practice template letters that can be adapted by practices for uploading to clinical systems, so that
GPs can easily report breaches to CCGs and providers.
We have also written to LMCs with template letters they can send to their local CCG and hospitals, requiring them to detail how they will ensure these contract rules are implemented.
We would encourage GPs who are experiencing inappropriate workload shifts to contact their LMCs who can escalate the matter on their behalf.
CCGs need to ensure that patients are getting appropriate care from all parts of the NHS and are not being passed inappropriately from secondary care to practices.
These changes are all about good patient care and CCGs should act decisively to implement the NHS standard contract.
Dr Gaurav Gupta is a GP in Kent, chair of Kent LMC and a member of the GPC UK
