GP leaders voting on same-day access concession offer made by NHS England

Exclusive NHS England has written to the BMA’s GP Committee with a concession offer regarding same-day access, which may see practices able to agree to reduce non-urgent access in exceptional circumstances.

Pulse understands that members of GPC England have been asked to vote electronically on whether to accept the concessions, or move to collective action, with the vote closing tomorrow (1 May).

GPCE had previously said collective action would launch this week if advice and guidance (A&G) contractual changes were not ‘paused’; and there were no ‘safeguards’ put in place for practices regarding same-day access demand.

NHSE set out updated guidance on A&G last week, and has now written to GPCE to outline their concession offer on access.

The letter said that practices would be given the possibility to reach ‘bilateral agreement’ with their ICB when capacity is reached, although only in exceptional circumstances – and practices need to have put systems in place to avoid getting overwhelmed by such demand.

It added that escalation in these cases is ‘not about practices closing their doors’ and that even during periods of ‘exceptional pressure’, practices ‘must continue to prioritise clinically urgent and high-risk patients where safe and feasible’.

Where a practice considers that ‘all reasonable internal mitigations have been exhausted’, any escalation should be initiated by a ‘named’ GP ‘who is taking professional accountability for that decision’, and should communicate with the ICB and reach a ‘bilateral agreement between practice and commissioner as to next steps’.

NHSE’s letter said: ‘Through our discussions, we have reached a shared view that a clear and proportionate approach is needed for practices managing exceptional demand and access pressures to keep patients, GPs and practice teams safe, while maintaining professional accountability.

‘We will be setting out a series of national principles, attached to this letter, which describe a high-trust, high-responsibility model that may be applied where practices are facing exceptional pressures and are temporarily unable to deliver all elements of their contract.

‘These principles are designed to be time-limited, proportionate and locally implemented, with
clear expectations on all parts of the system.’

NHSE will issue guidance next month to practices and ICBs on ‘how to plan for exceptional circumstances, both at a practice level and with wider system support’, the letter added, with the guidance to be ‘co-produced’ with GPCE.

The letter also seemed to reiterate a previous threat from health secretary Wes Streeting not to go ahead with bilateral negotiations for a new GMS contract with the GPCE if it took collective action.

It said: ‘Given the above, we hope we are in a position to move forward with you on the bilateral negotiations on substantive GMS contract reform across this parliament referred to in
Secretary of State’s letter.

‘Continued progress on that agenda depends on maintaining a constructive and stable environment for engagement.’

Dr Doyle said: ‘We have been talking constructively with BMA GPC England for a few weeks about the concerns they’ve raised. These talks are ongoing and we will continue to engage with the committee as they consider those discussions.’

GPCE members have been asked to vote on whether progress has been made on the asks made on Government, with some members telling Pulse they felt they were ‘nowhere close’.

They also pointed out that concrete plans for collective action still haven’t been communicated to practices. GPCE’s leadership had previously hinted that GPs could protest against the imposed contract by taking action around how general practice patient data is used by the Government.

GPC member Dr Manu Agrawal said: ‘Practices are asking us, what are we doing from 1 May? What action are we taking? And they have absolutely no clarity on what they are supposed to be doing.

‘The committee is voting on the proposals that have been sent to us, which don’t go far enough. However, practices still don’t know what action – if any action – they will be taking from tomorrow. Practices are expecting leadership and action from the executive, and they are not providing that.’

Pulse has contacted Department of Health and Social Care for comment. The BMA’s press office is currently unavailable due to being on strike. The GPCE’s executive did not comment.

Last week, talks between GPCE and NHSE led to the commissioner backtracking on a target for one in four GP referrals being diverted through new advice and guidance requirements.