‘Wholly inappropriate’ for GPs to give 24-hour clinical advice to all patients, says BMA
Exclusive The chair of the BMA’s GP Committee has written to primary care leaders at NHS England to ask them to clarify the patient charter published last week.
All GP practices will have to display the charter – which stipulates the rights of patients including on access and registration – from 1 October, but Dr Katie Bramall argued that one patient right was ‘wholly inappropriate’.
Titled ‘You and Your General Practice‘, the charter includes a requirement for the ‘practice team’ to ‘consider your request for an appointment or medical advice and tell you within one working day what will happen next’.
Although this is already a contractual requirement, Dr Bramall said NHS England’s wording – which the GPC had not had prior sight of – risked suggesting patients should receive medical advice within the time frame.
What does the GP contract say?
‘Once the patient or representative has contacted the practice by whatever means, the appropriate response must be provided: (a) if the contact is made outside core hours, during the following core hours; (b) in any other case, during the day on which the core hours fall.’
Speaking on the new episode of the Pulse in Focus podcast, Dr Bramall said: ‘I would argue, when it’s saying things like “oh, practices will respond within one day” – well, hang on, practices absolutely will acknowledge the receipt of a request within one day.
‘But to suggest or infer that there will be a response within one day – that kind of brings with it suggestions of clinical advice, which will be wholly inappropriate.’
She added: ‘I’m sure it’s a mistake, and I’m sure they’d be happy to clarify it.’
Dr Bramall said that although the ‘preamble’ to what they had seen regarding the charter had been ‘fine’, the ‘actual detail of that document wasn’t shared’ and she is now writing to NHSE primary care director Dr Amanda Doyle to ask for it to be corrected.
‘I’m actually in the middle of drafting an email back to Amanda and colleagues to say, look, you know this, this needs to come with us. You need to bring us with you on this. Otherwise, that’s not going to be mutual collaboration in good faith, and that’s only going to lead in one direction,’ she said.
Dr Bramall went on to argue that ‘appropriate safeguards’ have to be put in place before October to ensure that GP practices can safely triage patients to be able to prioritise those with the most urgent needs.
She said: ‘The thing is, patients, as we’ve been saying throughout, don’t present with a temporal definition of their problem. They’re not going to present saying “this problem is urgent” and “this problem is routine”.
‘They’re going to present with symptoms. And the Government, NHS England, has been banging on its modern general practice access drums since May 2023, advocating total triage.
‘And that approach means whether you present as a walk in, whether you present over the telephone, whether you present through online, that’s all supposed to be put together and triaged accordingly.
‘Now, taking that to its logical conclusion, your free text responses, one could argue, may well be urgent and may well expect an on-the-day response.
‘So I think we’re looking to how we can put in place those appropriate safeguards that NHS England have alluded to, that Government have agreed to, to make this workable, so that they can still feel safe come 1 October.’
NHS England did not provide a comment but explained that although the practice team should consider the request for an appointment or medical advice and tell the patient within one working day what will happen next, this does not mean that the appointment has to be provided on the same day.
It said that a patient will have clarity on what the next step is and when they will be able to see a member of the practice staff if that is the appropriate course of action.
It also pointed out that patients should never be asked to call back another day, as per the contractual requirement since 2023.
Listen to the full interview on the new episode of the Pulse in Focus podcast here
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READERS' COMMENTS [7]
Please note, only GPs are permitted to add comments to articles
Of course GPs should the ones offiering 24 hour care. It was the unique monopoly we had until Tony Blair’s premiership. Then, he brilliantly destroyed that power we had and split the profession. We were responsible for 24 hours care; we did not have to do it, and usually subcontracted it. We had respect from patients. Most GPs have no idea what we are missing. The core principle of general practice was ripped out. If there is any oppotunity to take that monoploy lead again in NHS provision again, the profession should grab it. Otherewise hospitals will continue to suck resources away from us. BMA is wrong yet again.
The truth is that successive governments have never quite forgiven the BMA GPC for the 2004 contract. All the rest, as you say, is just politics.
Don’t disagree but we don’t have the workforce to achieve this at the moment. If the funding that has gone to PCNs and other government bodies came into primary care then we could employ moe healthcare professionals to achieve this charter . It will just cause more angst for patients and doctors alike . When we have waiting lists like hospitals for appointments maybe Wes will wake up and see this but I doubt it . They seem determined to break primary care however they can . Let’s hope the BMA can support us and our staff before 1 October and give guidance to how we can deal with the increased workload without breaching contracts
I was a full time GP from 1983 to 2020 and then after retiring as a partner did locums for a couple of years. I experienced General Practice before and after the 2004 contract. Most GP’s I knew were fed up with the 24 hour responsibility by 2004. That change in the contract in my opinion has kept NHS General Practice limping along until now. 20 years later we now have a whole generation of GP’s who have not done the ridiculous 1 in 2, 1 in 3 hospital on call rotas and practice on call rotas. The concept of a full day in the practice then a night on call with probable disturbed rest and then another full day in the surgery will be quite alien to the current cohort of GP’s. It was unpleasant. I do not think people will put up with it.
The other issue will be funding. The 2004 contract covers 52 and a half hours a week. What will funding a 168 hour week cost the DoH?
The underlying problem is that they are trying to deliver care through rules, rather than resources.
The correct approach is to provide the resources required to meet demand. They can’t afford that so instead are going to provide less resources and then rules which try to bridge the gap. It has never worked before, it won’t work this time.
Work out how many appointments you want to deliver. Multiply that by £50 and fund the service that amount.
If you move more work out of secondary care, count the number of extra appointments needed, multiply by 50 and add that.
£50 increases with CPI each year.
It’s simple but it’ll work. Trying to bypass that with a load of nonsense about charters and rights will just result in wasting time through arguments.
I am afraid I agree with the comments, rather than the headline here
GPs are ideally suited with all the right skills and knowledge to provide 24 hour advice to patients, whereas many other services simply are not suitable.
The only problem with GPs is lack of capacity.
APPs have not yet shown any indication of being as good as a Local GP (or OOH GP) in this, generally, and will not until everyone can use them, which they cannot for many years yet.
There are loads of unemployed GPs, who could step up, but they are not ‘local’, and do not know th patients or areas yet.
The other problem is that the Charter appears to be trying to resolve the ‘8am scramble’ inappropriately.
There is not usually a problem handling most contacts some time during the following working period, but some danger in people being able to leave emergency messages that will not be answered until after weekend – but that problem already exists.
More of a danger to practices, is the part “(b) in any other case, during the day on which the core hours fall.’ “, which NHSE could interpret as meaning any contact received between 1820 and 1830, but be answered before 1830 that same day !
However, the best way around this would be to play gov at it’s own game : they want IT solutions? give them IT solutions !
Most Practices already do use a telephone system that advises people something like ‘in an emergency, hang up and dial 999’. This is clinical advice, and a suitable adjustment could cover all eventualities.
Need to know ‘what happens next’? Leave message on answerphone telling patient that it will be dealt with within next 18 working hours, or similar, and that if not hear back, to contact us again the following day. Fixed.