GP contract changed to require premises and phones remain open during core hours

GP leaders have raised concerns after the GMS contract was changed to require practices keep their premises, telephone lines and online consultation tools open throughout core hours from October.  

Announcing changes to the GP contract in February, NHS England told GP practices they would need to keep their online consultation tool open throughout core hours for appointment requests, medication queries and admin requests, from 1 October. 

But a contract variation notice published last week appears to go further in stating that practices ‘must take steps to ensure that all of the following means of contacting’ the practice ‘are available for patients throughout core hours’, including:

• by attending the practice’s premises; 
• by telephone; 
• and through the practice’s online consultation tool

NHS England told Pulse that there was no difference between the substance of what practices were told in February and the amendment of the wording to the contract, and that the updated wording was merely to emphasise the obligation to remain open during core hours. 

But GP leaders said that the change undermines practices’ ability to provide services flexibly and could destabilise practices.

Leicester, Leicestershire and Rutland LMC chief executive Dr Grant Ingrams told Pulse: ‘This is a complete mess which significantly undermines general practices’ ability to provide services flexibly to suit their patients. It could destabilise many practices. 

‘It’s the first step to moving away from having your contract, which is about delivering services for the needs of patients, to the wants of patients. 

‘Having a front door open requirement is about patients wanting to turn up whenever they want to, not whenever they need to.

‘It is taking away the ability of practices to sit down and decide what are the best services for their patients, within the very limited budget that we get.’ 

Dr Ingrams said the update also contradicts section 20 of the General Medical Services Regulations, which says a contract must ‘contain a term which requires the contractor to provide essential services, … at such times, within core hours, as are appropriate to meet the reasonable needs of patient’. 

‘This means that the regulations will now be internally inconsistent’, he said. 

YOR LMC medical secretary Dr Brian McGregor also raised concerns about the contract variation.

In a message to GPs, he said: ‘The regulation changes have been used to re-write the access requirements, and as they now read, every practice (potentially including all branch practices) needs to be open for walk-in patients during all core hours (08.00-18.30) and phones also on during these hours.

‘This is a clear and significant change which will have resource implications for staffing and expenses. The “shoulder” periods, 08.00-8.30 and 18.00-18.30, often subcontracted, may not be achievable under these conditions and closing for training (even PLT) or lunchtime will not be in alignment with these changes.’

Earlier this month, NHS England also published a ‘patient charter’ stipulating patients’ rights which GP practices must display on their website from October. 

The charter states that practices must be open from 8.00am to 6.30pm, Monday to Friday and that ‘throughout these hours’ patients are able to ‘visit the practice, call them, and go online using the practice’s website or the NHS App’.  

A BMA spokesperson said: ‘The BMA is carefully considering the implications of these changes for GP practices and we are in the process of producing guidance.’

The union previously warned that the requirement to keep online consultation tools open all day will likely cause a ‘temporary spike’ rather than a ‘sustained increase’ in demand.

In March, NHS England attempted to allay concerns raised by GPs about the move to mandate practices to keep online consultation tools open from 8am to 6:30pm.

During a webinar on the contract, NHS England fielded several questions from GPs who branded the requirement ‘unsafe’ for patients and said it could lead to staff ‘burnout’.

Pulse has approached the Department of Health and Social Care for comment.