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GPs plan to defy NHS England over Christmas early closure

Exclusive Practices are planning to defy the threat of a breach of contract notice from NHS England and close early on Christmas and New Year’s Eve, Pulse has learnt.

Londonwide LMCs confirmed at least two practices in London have said they will ‘definitely’ hand over to their out-of-hours service earlier than usual on these days, while Essex and Sefton LMCs said they believe ‘many’ practices will only be providing reduced services.

One LMC leader in Manchester has even claimed that practices there have been granted the option to close early by the local area team.

Pulse revealed earlier this month that head of primary care at NHS England Dr David Geddes had written to all area teams to insist that it was ‘non-negotiable’ that GP practices open for their full core hours on Christmas Eve and New Year’s Eve warning that practices which decided to close within core hours could be in breach of contract.

But LMCs have been writing to area teams challenging the latest NHS England directive stating practices must provide all usual routine and urgent care in core hours, after the GPC advised practices that they are legally entitled to close early.

Dr Tony Grewal, medical director at Londonwide LMCs, told Pulse he knew of two practices that would be closing early. Dr Grewal said: ‘I’m aware for definite of two practices. They are going to completely close their doors and switch over to an out-of-hours provider.’

He added: ‘If practices are going to close early I’d like them to just do it, and with luck NHS England will never find out about it. It’s such a waste of everybody’s time this ridiculous business.’

Dr Brian Balmer, Essex LMC medical secretary said he believed many practices would be operating with a scaled-back service – and that the LMC would be backing them to do so.

He said: ‘We’ve sent the [area team] a very strong email in support of practices, with GPC advice we believe to be legally correct. The area teams are being pushed by Leeds [national NHS England office] to do this. We will defend practices who fulfil their contracts properly.’

But he warned the area team could monitor which practices have flouted the national directive. Dr Balmer said: ‘I’m sure there will be some sneak phoning around practices on Christmas Eve.’

Similarly, Dr Andrew Mimnagh from Sefton LMC said many practices there were likely to ignore NHS England’s directive.

Dr Mimnagh said: ‘The issue is NHS England appears to be exceeding its remit by specifying to practices what “adequate” medical care for GMS is. All practices by their contractual definition will be fully providing services, but I would hazard a guess eight out of 10 GMS practices may not be servicing it in the specified manner of NHS England. And I understand the GPC has grown a set and indicated it will support any practice fulfilling its contract with whom NHS England takes umbrage.’

Dr John Hughes, honorary secretary at Manchester LMC, said practices had agreed with their local area team to close at 4pm on Christmas Eve and New Year’s Eve, before NHS England ruled out early closing –  and that the LMC did not expect this agreement to change.

Dr Hughes said: ‘It was a compromise agreement which most practices seemed happy with. As far as we have gathered from our area team, their view is they have made a satisfactory agreement with practices, that there hasn’t been any evidence in Greater Manchester of major demand over that time of day.’

A spokesperson for NHS England in Greater Manchester said: ‘GP practices shall retain clinical responsibility for the provision of patient care during contracted hours, and continue to offer access to routine and urgent care. In some situations practices may engage call-handling deputising arrangements for telephone calls.’

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Readers' comments (42)

  • I presume Dr Geddes and his team at NHS England will be working until 6.00pm on both the days in question! I think not. I am not a GP and when I leave my office on Tuesday next week at mid-day I will be one of the few still working in my area so I believe the hard working GP surgery staff should be given up to the half day extra off with pay. Such a small sacrifice would go a very long way.

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  • The sad thing is this will be counterproductive. In our area we have put on hundreds of hours of extra surgery time over the 3 week period around the holiday - in order to prevent our A+E falling over, including on the bank holidays. Our OOHs service also negotiated with our local NHS 111 to take and triage the calls from 4pm, before passing them through (so only one number for patients). To enfocre GPs and practice staff to sit around idly twiddling their thumbs for a handful of hours that has always been quiet in my 30 years as a GP, has created a really bitter taste and one wonders what cooperation we can expect from practices going forward. Do these people really get how to incentivise and motivate GPs?

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  • I would love to agree with you however I believe in equality across the NHS and unfortunately a 1/2 day isn't an option for hard working nurses who have patients to tend to. Should we differentiate between the two totally different professions and is it fair to? I'm not entirely sure what the answer is and until I am I have to stick to my line of equality.

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  • GP surgeries have a duty of care for their patients for the contracted hours. If they decide to subcontract that care then they must be sure that the subcontractor has the capacity and capability to deliver that care. Failure of the subcontractor will be the responsibility of the GP. Putting calls through to NHS111 earlier than 6.30pm could overload the service and put patients at risk.

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  • >Should we differentiate between the two totally different professions and is it fair to?
    ---

    There is no differentiation. Our nurses are also not working the half day (instead of spending it sitting there doing nothing at all in surgery).

    The issue here is that surgeries are contracted to meet the reasonable needs of their patients. Since there is no demand on Xmas evening, it is not unreasonable to close the surgery providing a plan is in place for emergencies.

    Overloading 111 is not an issue because special arrangements are being made (OOH to cover the 2-3 hours via a PAID arrangement) and also because 111 is appalling anyway and preventing people from accessing it is probably a public service.

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  • To the anonymous nurse above who talks about equality. Well what about all the extra hours GPs do in the weeks leading up to and after Xmas. In my practice GPs have been working till well past their contracted hours and after all other staff have left. It is a nonsense to talk about equality in this situation it isn't as if GPs will be leaving early while expecting employed staff to stay. Rather it is using common sense and knowledge about likely demand. NHS England's heavy handed manner will simply create a feeling of deep disillusionment.

    If GPs worked strictly to contracted hours NHS England might find primary care's efficiency greatly reduced.

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  • Anonymous 8.53 am. you are clearly referring to hospital nurses, who do not have the dramatic fall in workload that G.Ps regularly experience on Christmas Eve pm Would any sensible and reasonable manager in any business want a workforce sitting idle. I know that Dr, Geddes issued the edict but there is a strong whiff of politicians pulling the strings.

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  • As I have already done 40 hours work since Monday morning I would love to compare that with NHS England Stazi - I hope all GPs and there staff will spend the hours on Xmas eve - when there is no demand - phoning up their LAT questioning the payments they have [not] been receiving - that may also preclude them having the time to do their "secret shopper" games of finding the practices that have quite reasonably clossed early?

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  • Malcolm Ridgway has hit the nail on the head. dogmatic, publicity driven handling of something like this can only backfire.
    and of course you will be hard pressed to find anyone in LATS and related new organisations to be around that afternoon either, not to mention Friday afternoons

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  • Not a lot of Christmas spirit going on here. If you are absolutely convinced your deputising service will offer an adequate cover for your patients and protect A&E at a critical time of year then carry on and shut your doors at lunchtime. We are not a 9 to 5 profession.

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