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GPs told to open up appointment book for 111 direct booking of Covid patients

GPs practices must free up appointments for direct booking by NHS 111's Covid-19 assessment service from today.

GP contractual regulations have been amended to state that practices must make at least one appointment per 500 patients available for direct booking from NHS 111 each day - effective yesterday (14 April) until 30 June.

But this can be increased, at the discretion of NHS England and the health secretary, 'in some cases extending to the whole appointments book', NHS England said.

The requirement is one of a number of contractual changes due to the coronavirus (Covid-19) pandemic outlined in NHS England’s latest preparedness letter for GPs, published yesterday.

Other contract updates include a temporary amendment to the definition of ‘core hours’ to include bank holidays and enabling NHS England to suspend certain contract terms during the pandemic.

The letter said: ‘The GMS and PMS regulations, and APMS directions, have been amended to… increase the minimum number of appointments that practices must make available for 111 direct booking.'

NHS England said that following NHS 111 triage 'there will be a significant cohort of patients who are unwell enough that they need to see a clinician and many of those patients will need to be referred to their GP'.

The letter said: 'Previously, practices were only required to make one appointment per 3,000 registered patients per day available for direct booking by NHS 111.

'The amended Regulations give [NHS England] and the Secretary of State the power to increase that number, in some cases extending to the whole appointments book.

'From 30 March 2020 until 30 June 2020 all practices in England must make 1 appointment per 500 registered patients per day available for direct booking by NHS 111.'

Speaking in a live webinar last Thursday, NHS England digital lead Dr Masood Nazir said: 'Up until now, only about 60% of practices in the country have had GP Connect enabled for GP contractual obligations of allowing 111 to book into an appointment slot in their GP surgery.

'Clearly with the pressure on the national service increasing, what we need to do is to allow clinical assessment to occur and where appropriate, the patient to be referred back into the GP practice for further action or assessment.'

A previous GP letter had outlined that GPs will be expected to carry out ‘proactive’ monitoring of some patients with coronavirus symptoms once they have been triaged by the Covid clinical assessment service (CCAS).

GPs have also been asked to offer up their spare time to staff the CCAS, which is being set up as an extension of NHS 111's coronavirus (Covid-19) response. NHS 111 call handlers can refer patients to CCAS who require further assessment by a clinician to determine whether they need hospitalisation.

Meanwhile, GPs were told to ‘avoid’ sending patients with Covid-19 symptoms back to NHS 111 if they have been unable to get through to NHS 111 in the first place.  

What GPs need to do

  • Enable GP Connect for both appointment booking and record access.
  • Ensure nominal appointment slots are always available into which the National Covid-19 Response Service can ‘book’ patients into a work list. Patients will be told that they will be contacted by their practice with further information about the follow-up, not given a specific appointment time. No additional clinical triage will be required, but practices will decide how to deliver the appropriate care to each patient according to the record of the assessment already made and the local delivery model.

Source: NHS England's 27 March letter to practices

Readers' comments (42)

  • Are these face to face without GP telephone triage ?

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  • Another back of a fag packet guesstimate as to numbers of appointments required by an organisation that really are clueless. Appointments are finite, but if NHSE want to fill them with 111 dross, that is up to them. How that squares with being available to assess everything else and being ‘open’ as normal is beyond me. Joined up thinking - no chance. Wheels fallen off - definitely.

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  • doctordog.

    No, not until we have appropriate PPE.

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  • Thanks for that NOT!

    Someone else doing triage on my behalf and passing all the F2F risk to me.

    Bound to be a sure fire winner.

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  • Not until proper PPEs. Health and safety still stands.

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  • Yeah right.

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  • No PPE no see.

    Offer only telephone consultations.

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  • Not sure where this central dictat has come from suddenly and shows complete disjointed thinking and a lack of understanding of local arrangements and developments.Most practices had stopped patient and nhs111 direct bookings early in the pandemic to avoid the risk of symptomatic patients turning up at practices. I assume these are face to face requests as the CAS is clinician led so if triage on phone has been done properly, these patients may need f2f. Locally, most areas have set up hot Hubs for covid suspected cases (often run by the same nhs111 providers) at specific sites and most individual practices are beening used to see shielded and cold patients. This makes sense to avoid exposure to a larger cohort of the gp workforce to Covid, reduces ppe use (which the government thinks is a "scarce resource") and also for shielded patient safety. Now the suggestion is to bounce back to practices after a clinician triage? Pointless duplication and makes no sense putting GP staff and other patients especially the high risk at more risk. Better option would be direct booking into the local hot hubs. The point made above about doing this work, in addition to review of shielded patients (another total NHSE farce) and the suggested proactive monitoring of suspected covid cases in addition to business as usual is also a valid concern. NHSE thinks we are sitting in our practices twiddling our thumbs. I also find it very concerning that unilateral contractual changes to the Gms contract are being made on a weekly basis on a whim. Where is the Bma in all this? Hiding as usual. GP Practices are being completely unsupported in the whole situation, being used to mop up failures of other services with the only resource give so far being a pack of surgical masks and a roll of flimsy plastic aprons!

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  • 'in some cases extending to the whole appointments book', NHS England said.

    But at the same time they'd expect us to see all other non COVID19 cases (see prev article on Pulse)? This is setting us up to fail

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  • telephone triage by NHS 111 will now become telephone booking of all possible or probable cases to see GP face to face 07.00 to 23.00 for "clinical assessment";
    not going to happen

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