Why £240m telephone systems won’t help GPs fulfil their contractual duties

The Government has unveiled its long-awaited recovery plan for general practice. Anna Colivicchi looks at the changes around access.

When NHS England imposed the contract on GPs earlier this year, of all the questionable requirements, the one that struck most fear into the profession was the obligation to offer an ‘appropriate response’ to patients the first time they get in contact and direct them to the right service.

Even once the contract was published in full, there was ambiguity around what practices needed to do. What was meant by appropriate response? Could practices direct patients to 111 or A&E when reaching capacity? Some LMCs had warned that 111 and A&E would be swamped by this new requirement.

The GP recovery plan, which was published yesterday, seemed to shed some light – but not in a positive way for practices. Unsurprisingly, it prioritised making it ‘easier for the public to contact practices when they are open and get a timely response.’

The recovery plan makes it clear that redirecting patients to 111 should only be in ‘exceptional circumstances’ and that local ICBs need to be alerted.

However, as pointed out by Berkshire Buckinghamshire and Oxfordshire LMC, the official regulations make no mention of ‘exceptional circumstances’ nor any obligation to inform the ICB – and that the plan, as well as guidance from NHS England is not laid out in statute and has no contractual force in its own right.

The carrot in the plan was the £240m funding for practices in England to ‘embrace the latest technology’. This wasn’t much of a carrot, however. The plan says that this money was ‘retargeted’, with the Department of Health and Social Care clarifying to Pulse that it was ‘existing departmental funding which has been newly allocated to primary care’. However, it is not clear where it is being retargeted from.

But also, this might sound familiar. Then-health secretary Sajid Javid’s 2021 £250m Winter Access Plan had said NHS England would ‘enable and drive full adoption of cloud-based telephony across all practices, as rapidly as possible’. While NHS England did not tell Pulse exactly how much of the winter fund was spent on cloud telephony, it did say that a total of 2,420 practices, covering 24 million patients, that didn’t already have cloud-based telephony took it up by the end of February 2022.

Even this funding doesn’t come without a stick. This year’s imposed GP contract stated that GP practices must procure cloud-based telephony once their current telephone contracts expire, and that only cloud-based platforms will be supported in practices from the end of 2025.

To receive the funding support, practices must sign up by 1 July. They can expect an average of £60,000 to support the move to digital telephony, digital tools, and transition support over the next two years, according to the recovery plan.

NHS England also highlighted that it has simplified forms to join a new practice and created an ‘easy-to-use online registration service’, available through the NHS app and already in use across 750 practices, with up to 2,000 practices expected to use it by December.

It also said it has provided practices with digital materials including posters and letter templates, aimed at ensuring that access routes to general practice are ‘inclusive and that patients understand how and when to use them is vital to overcome barriers which prevent some patients who wish to request care from doing so’.

This is not an insignificant sum of funding. But this is not getting to the heart of the problem.

The RCGP said the plan ‘outlines some encouraging initiatives,’ including the investment into telephony, but that none are ‘the silver bullet that we desperately need to address the intense workload and workforce pressures GPs and their teams are working under’.

The BMA agreed that new technology is ‘urgently needed’ to help replace the ‘archaic IT systems’ that many practices still use, but that GPs need more details on how this will address the growing exodus of doctors who are leaving the profession.

Dr Steve Taylor, a GP in Manchester and GP spokesperson for the Doctors’ Association UK, says that the tech ideas that the Government labelled as ‘new’ are already operational in most surgeries. The issue isn’t how quickly you get through to GP practices,’ he says, ‘the issue is when you get through are there enough appointments. The answer is no. Because there aren’t enough GPs.’

Chief executive of Londonwide LMCs Michelle Drage echoes this saying that ‘better telephones don’t create more receptionist to answer them, or appointments for patients to be allocated’. Meanwhile, most of the other services that patients might be ‘signposted’ to already have long queues.

And Dr Dave Triska, a GP partner in Surrey, says that when more than 400 patients a day call his practice, extra phone lines ‘don’t give you extra staff to manage it.’  

But these arguments don’t change the fact that practices now have a contractual obligation to ensure access – albeit via a contract they had no say in. What happens when the inevitable occurs – when patients are unable to get appropriate responses due to staff shortages – will be both crucial and frightening for practices.