Government must ‘wake up’ to online access ‘catastrophic mistake’, says GP leader
Exclusive The Government must ‘wake up’ and realise the ‘catastrophic mistake’ it is making by pushing through online access contract changes, the BMA GP committee chair has said.
From Wednesday next week (1 October) GPs will need to keep online systems open for patient requests between 8am and 6.30pm for routine enquiries but the BMA has demanded a deferral, which has not come to pass.
Dr Katie Bramall told Pulse that GPC England has continued to seek ‘necessary safeguards’ ahead of the requirements becoming contractual, but ‘to no avail’. And she vehemently denied that the BMA had agreed to the onus being on practices to implement safeguards.
Dr Bramall told Pulse: ‘We have emphasised consistently from the start, that without the technical functionalities in place, these moves will do the opposite of “bringing back the family doctor”.
‘They will reduce GP access and appointments, as GPs will be removed from scheduled surgeries to triaging online demand.
‘This is unfair, unsafe, and unwarranted. Sadly, it looks like whilst patients can trust their GP, GPs can never trust politicians. We can only hope that the Government will wake up ahead of next Wednesday, and not choose to make such a catastrophic mistake with the profession.’
In a letter to health minister Stephen Kinnock on 17 September, seen by Pulse, Dr Bramall listed some of the safeguards that would need to be put in place, including:
- removing any free text box to prevent patients submitting ‘urgent clinical requests erroneously’
- allowing patients to only select specific non-urgent requests or queries via tick-boxes
- directing patients to call the practice if their request or query is urgent
She said that without these safeguards the changes ‘become very problematic’ for practices in terms of ‘heightening’ the risk to patient and practice staff ‘due to overwhelm’.
The solution, she added, would be for NHS England to agree to a buffer period until April next year for practices to implement the changes with support from ICBs.
Dr Bramall said: ‘The solution here is to clarify that from October 2025-April 2026, NHSE will work with ICBs to continue to support GP contractors’ online development in practice, whilst continuing to work with GPC England and the joint GP IT committee in good faith and in the spirit of mutual collaboration to agree the functionality required to deliver what the health secretary has asked for in practice.’
NHS England has confirmed to Pulse that there is no such buffer period and the changes are coming in 1 October as planned.
Dr Bramall’s letter also added that the terms used by Mr Streeting during the BMA’s special representative meeting, where he called parts of the profession ‘laggards’, were ‘received very badly’.
Dr Bramall added: ‘General practice has been paperless for decades. We have electronic prescribing; online referrals; online consultations, cloud-based telephony, and are by far the most technologically advanced NHS sector when it comes to IT systems and logistics. Our concerns remain rooted in patient safety.
‘Finally, we will reach the end of the road around the 25/26 contractual changes right in the middle of the Labour Party Conference. Failure to reach a reasonable middle ground will undermine the trust that we have all worked so very hard to build over recent months.
‘So many challenges can be resolved without the need to spend or find new money. This is notable at the present time. I still believe there are substantial opportunities ahead if we work together to resolve these issues ahead of 1 October.’
The BMA is arguing that the online systems cannot differentiate between urgent and non-urgent queries and therefore serious issues risk being missed.
GPs have also warned that the changes could undermine practices’ ability to provide services flexibly and could destabilise practices, and that there is a risk the policy will cut back on access to face-to-face appointments.
Last week the BMA announced that, following a GPC vote, English GPs will re-enter dispute with the Government – over the contract changes as well as the 10-year plan for health.
It comes after ICBs have been told by NHS England that they should ensure GP practices implement the changes next week.
Pulse has contacted the Department of Health and Social Care and NHS England for comment.
Listen to the newest episode of Pulse in Focus: The Podcast for GPs, for a breakdown of the changes to online access, what they will mean for practices, why GPs are concerned, as well as why the BMA has re-entered into dispute with the Government over it. Listen here.
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READERS' COMMENTS [11]
Please note, only GPs are permitted to add comments to articles
Streeting is setting up GPs to fail. He knows he cannot force the 10 year plan through without GPs and hopes to grind them into submission. I hope GPs keep their nerve, go back into dispute, work to contract and leave Streeting to face the music when his bullshit 10 year plan unravels
It is a quantum leap to imagine offering our patients a friendly easy to use competent online access/requests , it will almost certainly dramatically increase the number of requests ( no old style phone queues deterring many) but if done well can revolutionise access. There is software already there like “ask my GP “ it’s a steep learning curve but can bring astonishing efficiency and truly help reach an almost same day service. 3 years in we have 80% annual requests made only digitally (20% are elderly who we accept phone calls), and sparingly only 9% request face to face (we actually end up with 25-30% after clinician triages and that’s only 8-12 Ftf per gp) and roughly 35% completed by phone and 35% email. Average time to completion of phone or email or a personal call agreeing a Ftf is actually needed is under. 90 minutes. You can see why uk gov is pushing this agenda as there are examples of it working very very well and overwhelmingly happy patients. But it needs resources to get it started and additional capacity to cope with the initial surge.
Had 30 online consultation messages between 8 and 5pm today, mostly acute issues. A few patients asking for routine appts for fungal nails and maybe need a hearing aid but want ears checking etc. One patient deferred to pharmacy first for sore throat. Then after 5, had another 18 from, presumeably, people who’ve finished work and gotten home for the weekend – only one of these was non-urgent (patient asking if I’d had a letter from the clinic about vagifem) – the rest were “acute unilateral swollen leg, made it into work but worse through the day, hot”, “temp 38.5 and really chesty but can’t go A&E was traumatised last time I was there as they made me sit in waiting room for 2 hours”, “sonny has a rash that I am not sure goes with a glass could I bring him down now?”. I don’t mind patients having access but the message has, again, deliberately, not been sent that this is a non-urgent service by online triage. The software is rubbish – “this sounds like an emergency – do you still want to contact your practice?” (what do you think the patients will say…?!). Shall I employ 2 salaried doctors to work 5-6:30 every Friday with me? or just accept this is general practice now and wait for the complaints? Wes?
Good news, ohh wait Partners/ PCN Directors have to sacrifice some pennies of their £300k to employ some more PAs and salaried 🙂
Online access is a very big step up from phoning into Reception to ask.
But many patients have not even managed yet the step up to using the phone from the old method of just walking up the hill to the surgery and sitting there until seen.
If Wes can’t make everyone use an analogue phone, how on earth will he make everyone use a digital phone?
Or is it just to ensure those who don’t use mobile Apps, just will not get seen?
If the Government keeps trying continually to trick the BMA Negotiators/GPs, then it is inevitable that sooner or later they will trick them, and then they will completely lose the trust of gPs and everyone else!
We use RapidHealth and keep our online systems open 24 hours a day. Works well. Took time to implement it. Not perfect but does the tick box stuff to ensure safety.
I guess the biggest issue is that there is no definition of routine, you should be using that to your advantage. We are creating a routine waiting list and assigning very very few resources to it (lets say one appointment a day). That list will quiclkly grow to several months long.
So our definition of routine is something which will not be impacted at all by a delay of several months – I’m not sure there are many things I see each day which will fall in to that category.
So – if it does, they get a message saying they are on the list, expect to hear next Spring, but they can book routine stuff in to our normal daily allocation if they prefer.
And the vast majority will not fall in to that category and will get a routine text message and be handled in exactly the same way as they are now when the allocation is full.
What a mess
Safe triage needs senior GP- these will be pulled out to do triage during core hours ….. significantly reducing capacity. Also continuity of care linked to better experience and mortality will suffer. Access inequalities will worsen as those with wants will push out those with genuine clinical needs. GP teams would like the capacity to reach out to the vulnerable and the digitally excluded..
Really depends on your practice population. I work in two practices with a high level of deprivation and frequent use of Language Line – no idea how many will be able to utilise this. However, we continue to create policies and allocate funds to appease the middle-class, worried well.