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GPs threatened with breach of contract over 'diverting' calls to NHS 111

A row has broken out between LMC leaders and NHS England after officials threatened all London GP practices with contract breach notices if they continue to divert phone calls to NHS 111 during the day.

The letter, sent to all London GPs last week, quoted clauses from the GP contract and warned that NHS England would issue contract breach notices to practices if patient calls continued to be diverted to NHS 111 during core hours.

But Londonwide LMCs said they had not seen any evidence to back up the claim that practices were diverting patients to NHS 111 and have written to NHS England’s London area team asking them to withdraw the threats.

The letter from NHS England said that GP practices were contractually obliged to have ‘suitable arrangements’ for patients to access care in-hours, but that there were ‘increasing numbers’ of GP practices diverting patients to NHS 111.

The letter says: ‘It has recently come to our attention that there are an increasing number of examples where GP practices are diverting patients to 111 during their core hours.’

‘[R]egardless of whether your contract is GMS, PMS or APMS, does not constitute the Contractor having “in place arrangements for its patients to access such services throughout the core hours in case of emergency”.’

‘NHS 111 has not been commissioned as a service to either “cover” or “substitute” for general practice during its core hours of responsibility or to handle routine in-hours calls from patients who are attempting to contact their GP practice.’

‘Please be aware that a breach notice will be issued to any practice which is not making suitable arrangements for its patients to access essential and additional services during its core hours.’ Click here to read the full letter.

But Londonwide LMCs medical director and Hillingdon GP Dr Tony Grewal cast doubt on the ‘fairly unpleasant’ letter, saying there was no way of telling how a patient got through to NHS 111.

He said: ‘In writing back, what I said was that the letter was at best unfortunate in tone. That there was no evidence of practices not fulfilling their contract and more importantly, because of the way the 111 system and phone answering work, there is no way of telling whether a practice is using 111 to deliver in-hours services or whether a patient has got through to 111 by one of the other routes. I have had no response.’

‘We had actually already warned practices not to divert calls to 111 some weeks before but practices discovered that in some cases their cover organisation was flipping calls though to 111 because they had not made different arrangements for in-hours cover and for 111. It is part of the fact that no one has thought through the changes involved in the shift to 111.’

GPC deputy chair Dr Richard Vautrey said the letter was ‘very heavy handed’ and that it was unfair to blame practices for the problems with the service.

He said: ‘It is just a consequence of trying to roll out NHS 111 in a too hasty way and not thinking through the potential knock-on consequences and providing a solution before implementing it.

‘[NHS England’s letter] is not inaccurate, GPs have a contractual duty to arrange in-hours cover, but I think it is unfortunate in its tone, threatening breaches in that first letter.

‘It would be far more appropriate for them to highlight concerns and then offer solutions rather than writing out something in an officious and threatening manner. I think it doesn’t bode well for the relationship that the new NHS London teams will have with practices, and we really need to see a move away from that type of tone. Practices need to be worked with, not threatened.’

An NHS England spokesperson said: ‘The NHS 111 contract is clear that it should not be used by GPs during normal working hours when arrangements for patients should be in place.

‘To help manage any issues, Primary Care Commissioning heads in London wrote to GP leads and Practice Managers to clarify their contractual obligations for core hour support to patients. NHS England is working with local CCGs to consider all aspects of the NHS 111 service and to ensure the service is designed and commissioned in the best possible way to meet the needs of patients and the public. The letter was shared with the Londonwide LMC in advance of distribution.’

The news comes as the Government wants to make GPs ‘more accountable’ for out-of-hours care, with contract changes to be discussed as part of the negotiations for 2014/15.

 

Readers' comments (15)

  • Presumably if GPs become more accountable for Out of Hours services and they have no contractual requirement to contact 111 they could return to diverting calls to their chosen contracted OOH service and leave the DoH paying for comemrcial contracts with underutilised 111 service, with no access to local OOH services run by GPs, therefore paying for their/CCG commissioned duplicate OOH services? I am genuinely curious on the contractual aspects of OOH under any new arrangements for it's commissioning and it's relationship with 111 (CCG fintegrating both 111 and OOH now v GP for OOH only fragmented from 111 and CCG in future), does anyone know the answer?

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  • Harry Longman

    The omnishambles of 111 rolls on. DH, having decided to keep a dog and bark itself, is now complaining that the original dog can't be bothered to bark (even though it considers the new robot dog to have a feeble robot bark which scares no one).
    You couldn't make it up. Though you could predict it. As as taxpayer, I'm dumbfounded.

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  • Peter Swinyard

    Brilliant Harry !!!

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  • Azeem Majeed

    A typical heavy-handed response from the Primary Care Units in the London Local Area Teams. If there are practices that are using NHS 111 inappropriately, the letter should have gone out just to them, rather than to all practices in London. In my practice, we don't use NHS 111 during core hours and receiving this letter was a waste of both our GPs' and practice manager's time.

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  • I don't understand why the media portray the 111 service as a replacement for NHS Direct. It is clearly much more than that - a gatekeeper to the OOH service.

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  • It is very tempting to view this as just part of the longstanding Londonwide LMC vs NHS management impasse, but think broader.
    This is merely one of many strategies that will seek to conceal, then spin the facts of catastrophic mismanagement and launch failure of the former NHS direct portion of NHS111 ,until the parties of power can lauch a red top broadside that unreasonable action of the medical profession is the route cause of failure of the 111 service
    I have already had :-
    on variation between pilots " Nottingham LMC did not like us and encouraged overload and complaints"
    On launch failure " Well apparently there was a GP study day that we did not know about in one part of the reigion that caused the overload"
    And on the issue that no clinical feedback to the CCG
    " the contract is at a reigional level"
    The reality that it was only ambulance service and social enterprise / Gp co-operative/private providors who hold small 111 contracts that stopped a total meltdown of 111 service, is being suppressed.
    All we hear of late is how much better NHS direct is doing using all financial resources to handle a fraction of its contracted activity.
    Look for the trend- GP's are to carry not only the accountability to make it work, not only the duty to rectify the service at a cost of millions the exchequer does not have, but aslo the final killer blow of being labelled as the cause of the failure in the public eyes.

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  • General practice is not an emergency service. It is not funded as such and therefore cannot provide the capacity to be such.
    Until there is a rational dialogue about "emergency", "urgent" and "routine", and who is responsible for what and when, there will always be wriggle room for parties to pass the problem to the other.
    We also need leaders with the courage to publish an analysis of the use of all aspects of NHS care showing just how much money is being spent in each area and more importantly, just how much of that on care delivered in an inappropriate setting.
    Finally, GPs need to know that their leaders will back them when remonstrating with patients who use urgent and emergency care inappropriately.
    Must go - there's a pig flying over.

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  • Correct me if I am wrong but wasn't the aim of 111 to take the calls of those needing advice 24/7 and direct them to the most appropriate provider? So if persons are calling during the day surely the answer is do what is appropriate, give them advice, direct them to the GP, or direct them to another service whatever is appropriate. Where did it say people cannot ring 111 during the core hours their GP surgery, or is it those who come up with the old chestnut I cannot get through to my surgery.

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  • ". . .those who come up with the old chestnut I cannot get through to my surgery."


    Not so much an old chestnut, my anonymous friend, but a fact of life for many patients. Too many, perhaps.

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  • Good for NHS England. Its about time practices were expected to be open all of core hours with GP's avaliable. In my CCG, they all shut for thursday afternoon and have the time off, or do private work elsewhere. If you call you get push through to the OOH service. And guess what, there is a huge spike in A&E attandances on thursday afternoon from those practices.

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