GMS practices are entitled to subcontract services to ‘an appropriate provider’ if they perceive there will be low demand for services, as experienced by many practices on Christmas Eve and New Year’s Eve, which a subcontractor will be able to meet.
NHS England has now revised its guidance on Christmas opening to reflect this, after a practice issued with a breach notice for closing early in 2013 won its legal battle to overturn it.
So in an effort to clear up any remaining confusion, here are the rules, along with some tips on how to prepare for the festive period.
How to subcontract
Practices with historically low demand on Christmas Eve and New Year’s Eve may decide to close early.
To subcontract services on these days, practices must apply in writing to the area team or CCG as soon as possible. Strictly speaking, the contract holder must apply, though practices may apply as a group, or the LMC may apply on behalf of all opted-in practices, as we do in our area. Here, practices pay the LMC to arrange cover from the local out-of-hours provider and we have agreed practices can close at 4pm.
NHS England or the CCG can only refuse to allow the subcontract if:
• Patients’ safety would be at serious risk.
• The commissioner would be at risk of material financial loss.
• The subcontractor would be unable to meet the obligations.
If a practice chooses to cover its own requirements for the afternoon using one of its own GPs on call or subcontracting to a single healthcare professional, there is no requirement to seek area team or CCG consent. Different rules may apply for PMS and APMS practices.
How to prepare
Warn patients of closures using surgery notices and messages on repeat prescriptions.
Recorded messages that divert patients to the subcontractor after early closing should divert to NHS 111 from 6:30pm. Send special notes on vulnerable patients to the out-of-hours service.
Between 23 December and 6 January, reduce pre-booked appointments and routine consultations, or avoid them altogether. Extend repeat prescriptions to avoid renewal falling within this period. Also, make sure residential and nursing home patients have repeat prescriptions and know the opening times. It is good practice to review any sick patients before closing.
Dr Saqib Anwar is a GP in Oadby, Leicestershire, and medical secretary at Leicester, Leicestershire and Rutland LMC
