GPs told to keep online consultation tools open despite trade dispute

GP practices still have to comply with new contractual obligations coming into effect on Wednesday – but they will be ‘working under protest’, the BMA has stressed.

The union has given the health secretary 48 hours to avoid dispute with GPs over the contractual changes which will mean that GPs will need to keep online systems open for patient requests between 8am and 6.30pm for routine enquiries regardless of capacity.

However, in a blog post the Department of Health and Social Care said they did not agree with the BMA’s safety concerns.

The BMA’s GP committee is arguing that because the systems cannot tell the difference between routine and urgent, serious problems could be missed if safeguards are not in place – and has voted in favour of re-entering dispute with the Government on 1 October over the changes.

Now GPC England deputy chair Dr Samira Anane has clarified that despite the union being in dispute, practices must still comply with their new requirements to avoid receiving remedial or breach notices from ICBs.

Meanwhile, one large LMC has advised its practices that they should cancel clinical sessions so that GPs can be redeployed to safely triage the expected increased demand from ‘limitless inbound requests’.

The Government said today in a new document on the changes that keeping the online consultation tools open during core hours will not ‘lead to GPs being overloaded with requests’.

It stressed that the requirements will not ‘lead to serious cases being missed’ as GP websites ‘will feature clear instructions’ telling patients requiring urgent care ‘to phone their GP or attend in person’. 

As revealed exclusively by Pulse, the GPC demanded a deferral until the changes can be implemented safely, but this has not come to pass, and ICBs have been told by NHS England that they should ensure the changes are implemented.

In a message to GPs, Dr Anane said: ‘We dispute that it is safe to proceed with these contractual changes at the present time.

‘The BMA’s GPCE would be establishing a trade dispute with the Government on behalf of practices in England. This would confirm that the profession does not agree with changes being implemented (contractual) and proposed (NHS 10 Year Health Plan).

‘However, to ensure there is no risk of remedial or breach notices, even though a trade dispute is established, practices must still comply with their new contractual obligations from 1 October.

‘However, the trade dispute would establish that the profession does not agree with the change – on grounds of risk to patient and staff safety – and is “working under protest”.’  

She added that the next potential escalatory step includes balloting affected BMA members on whether they would be prepared to undertake proposed industrial action – ‘non-contract breach or otherwise’.

As part of the new requirements, by 1 October practices will also be required to allow community pharmacy to send consultation summaries into the GP practice workflow, using GP Connect Update Record – but the BMA warned that the technology is currently ‘not fit for purpose’.

It has called on the Government to ensure GP practices – as data controllers for patient records – are covered by indemnity relating to information added by other NHS providers.

Dr Anane said that the Government now ‘has one last chance’ to avoid dispute by ‘giving explicit assurances’ that either:

• it will ensure that the ‘necessary safeguards’ to avoid patients ‘erroneously submitting urgent online consultation requests’ will be implemented before 1 October, or
• ICBs will be ‘explicitly instructed’ not to issue remedial or breach notices until the necessary safeguard have been put in place.

The BMA has also provided a template letter for GPs to send to their ICB to notify that they are ‘working under protest’ and stating that the profession does ‘not agree with the manner in which these changes have been implemented’.

In advice to practices, seen by Pulse, Berkshire, Buckinghamshire and Oxfordshire LMCs said that clinical sessions should be cancelled to allow GPs to focus on safe triage.

It added that this will inevitably result in waiting lists for routine appointments, which itself will necessitate further staff redeployment to manage, and that waiting lists ‘should reasonably be expected to run to indefinite length’.

It comes after the BMA warned that the changes will force GPs to create waiting lists for routine care.

The LMCs added: ‘When safe capacity is reached, and it is no longer possible to safely assess each online consultation request to determine whether it is truly routine or urgent, we recommend the practice notify the ICB and LMC that they have reached safe capacity and are redirecting patients in the interests of safety.’

It also said that practices should ensure ‘realistic and safe in-person contact with the practice’ by way of ‘intercom, door buzzer, or remote doorbell systems’ so that doors can be ‘safely closed’ when necessary – for example during handover periods and ‘other times when staffing may be short’.

Regarding GP Connect Update Record, BBO LMCs said that administrative and, where necessary, clinical staff should be redeployed to allow safe coding and redaction of inbound documentation.

The BBO LMC advice said: ‘We recommend diverting resource away from unpaid or underpaid third party administrative requests, such as reports, letters, and requests for information from other Government departments.

‘Such routine reports should be added to an administrative waiting list (again, of infinite length) so that safe data governance of GP Connect Update Record can be prioritised.’

The Government said the BMA ‘signed up to and agreed this policy with GPs’, and that the Department of Health and Social Care remain ‘committed to wanting to work together to implement this as efficiently as possible’.    

It added: ‘This move will support GPs to care for their patients who need non-urgent care. GP websites will feature clear instructions telling patients requiring urgent care to phone their GP or attend in person. 

‘There are GP surgeries already successfully rolling out online appointment requests, showing it works for patients and practices.’

It said that practices who weren’t already offering this service ‘were given six months’ from when the contract was agreed ‘to prepare for this change’.

It added: ‘Evidence shows that where GP practices have moved to this model, both staff and patients have reported a smoother workflow and a better service. 

‘One London GP surgery which adopted this approach to online bookings reduced waits from 14 days to just three – with 95% of patients seen within a week.’

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.