GPs will from next month be contractually obliged to offer a response to patients the first time they get in contact, which will include ‘communicating with the patient’ or directing them to appropriate services.
The changes to the regulations regarding access were laid before parliament on 18 April, and will come into force on 15 May.
Following the imposition by NHS England last month, the contract was changed to say that ‘an appropriate response’ must be provided to patients the first time they contact the practice, and defined the response as:
- ‘invite the patient for an appointment, either to attend the contractor’s practice premises or to participate in a telephone or video consultation, at a time which is appropriate and reasonable having regard to all the circumstances;
- provide appropriate advice or care to the patient by another method;
- invite the patient to make use of, or direct the patient towards, appropriate services which are available to the patient, including services which the patient may access themselves; or
- communicate with the patient— to request further information; or as to when and how the patient will receive further information on the services that may be provided to them, having regard to the urgency of their clinical needs and other relevant circumstances.’
The regulations also said that the response must ‘where appropriate, take into account the preferences of the patient.’
The BMA expressed concerns around the new requirement, saying it believes it ‘is not achievable for many practices with current resource and workforce.’
And at the end of last month, the GPCE made clear that the new contractual ban on asking patients to call back at a different time will not mean having to offer them an appointment on first contact.
Earlier this week, the BMA also published new guidance on care navigation and triage, in order to help GPs signpost patients appropriately either within the practice or elsewhere.
During a webinar last month, Dr Clare Bannon, a member of the GPC executive, clarified that the ‘response’ outlined in the contract changes does not necessarily mean offering an appointment, but it includes signposting to other services, including 111.
While the union warned that there is ‘no standardised system for care navigation or triage in general practice’, it offered tools to ‘support practices to implement a system that can be adapted to a practice’s individual circumstances.’
The contract changes in full:
- For paragraph 4 of Schedule 3 substitute—
“Contact with the practice
4.—(1) The contractor must take steps to ensure that a patient who contacts the contractor—
(a) by attendance at the contractor’s practice premises;
(b) by telephone;
(c) through the practice’s online consultation system; or
(d) through any other available online system,
is provided with an appropriate response in accordance with the following sub-paragraphs.
(2) The appropriate response is that the contractor must—
(a) invite the patient for an appointment, either to attend the contractor’s practice premises or to participate in a telephone or
video consultation, at a time which is appropriate and reasonable having regard to all the circumstances;
(b) provide appropriate advice or care to the patient by another method;
(c) invite the patient to make use of, or direct the patient towards, appropriate services which are available to the patient,
including services which the patient may access themselves; or
(d) communicate with the patient—
(i) to request further information; or
(ii) as to when and how the patient will receive further information on the services that may be provided to them,
having regard to the urgency of their clinical needs and other relevant circumstances.
(3) The appropriate response must be provided—
(a) if the contact under sub-paragraph (1) is made outside core hours, during the following core hours;
(b) in any other case, during the day on which the core hours fall.
(4) The appropriate response must—
(a) not jeopardise the patient’s health;
(b) be based on the clinical needs of the patient; and
(c) where appropriate, take into account the preferences of the patient.”
READERS' COMMENTS [16]
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Totally Impossible ask by NHSE given the current workforce and resources available. I really don’t know what they are thinking. Do they really want the collapse of general practice? I really don’t understand the wisdom in imposing this and unless there is a cunning plan behind this which I can’t see (eg most practices breach and then what?), it reeks of total incompetence and lack of understanding of general practice ground zero. This shows a level of disdain for general practice and or an assumption that we will break our backs and find a way…. . as we always do no matter what is thrown at us. But this…. really is time to give up and needs an urgent plan B. BMA offering “tools” to this imposition is a complete weak non response.
Here we go. It’s going to be horrendous especially as we approach summer holidays but may finally collapse things enough for a plan B from the BMA for next April.
The appropriate response is call 111. Let 111 triage it all.
Then when 111 tell them they need a GP appt the patient can call the surgery back.
Should overload A&E and 999 though as 111 not brilliant at triage.
Oh well
File under “Ignore ”
Exactly why any self respecting doctor should not be working for NHSE!
All this does is up the day to day grief that Practices have to endure for Service Failure.
Long gone are the days when we could bail out the System with goodwill, just make sure that you and your staff’s health doesn’t suffer from this abuse.
No sign of issuing such dictats to secondary care btw!
Plan B is long overdue, and following Wes’s utterances, even the most fervent advocate of the current set up must realise that the game is up.
Not a contract an imposition is unachievable breach of contract don’t care any more.What are they going to do.Do they not realise locum costs.Time to accelerate the collapse.The BMA don’t have the balls to come up with plan B.The a consultant based organisation.We are underlings who fund them we are not fit to wipe their shoes.Time for them to do it themselves.
Actually this access requirement for the first time recognises that not all demand must be met by the practice. It recognises alternative providers may be appropriate. It doesn’t stipulate clinician triage (which is an appt by another name). So it’s reception triage. Must be fail-safe. The only appropriate response is 111 or A+E when we bust the 25 – 35 patient limit, which is only best practice, after all (per the BMA). I don’t see this contravenes the letter of the contract at all. NHSE have shot themselves in the foot with this one.
thank god i am out !
though working as a locum, in wales, where it hasn’t been imposed…………..yet !
I thought this is what we do now so what is new?
Nhs 111 !!!? . You try it
Retire
Locum
Emigrate
Is an entirely “appropriate response” to this shower.
Let the general public be seen by barefoot doctors and other such practitioners. Bye!
Appropriate response involves full extension of the middle digit
Let’s develop private practice. Sick of being run by these C grade managers. Professionals self manage and we are our own boss.
Is that his not what we already do, day after day already??
A&E…. Failing that, GP appointment.
Exactly, Genelle Haskins, that’s what we already do and have been doing only… since forever. Should be obvious to anyone bothered to read actual document.
We are in danger of over hyping this a little bit. No need to cry wolf while looking at an obvious lame duck. The thing about wellbeing, while also easily deliverable, is a lot more irritating in how tone deaf it is. This is just hearingly impaired. NHSE are probably just trying to smooth out inequality of access in their own semidetached from reality way.
First comment is that 15th May is when the amendment to the regulations comes into force. Whether practices will have to implement any change will depend whether practices have been served a change notice by that time..
Also the regulations state “The contractor must take steps to ensure that a patient …” So my reading of this is that as long as practices have taken steps, regardless of whether a patient gets an ‘appropriate response’ they have fulfilled their contractual requirements.