GPs need to triage patient requests but not give next-day clinical advice, NHSE clarifies

Exclusive NHS England has clarified that GP practices are not required to provide clinical advice to all patients ‘within one working day’ – following concerns around requirements published in the patient charter.

However it has stressed that there does need to be active triage – with the patient needing to be told what will happen next, rather than just an automated acknowledgement message.

All GP practices will have to display the charter – which stipulates the rights of patients including on access and registration – from 1 October.

But as exclusively revealed by Pulse, GP leaders raised concerns around one of the requirements included in the charter, which says the ‘practice team’ should ‘consider your request for an appointment or medical advice and tell you within one working day what will happen next’.

BMA GP committee chair Dr Katie Bramall said that NHS England’s wording – which the GPC had not had prior sight of – risked suggesting patients should receive medical advice within the time frame.

According to a message distributed via LMC newsletters, NHS England has now clarified that the ‘within one working day’ refers to the ‘SMS/email which is sent by NHS systems acknowledging receipt of the patient’s query’, and is ‘not an expectation of clinical judgement’,

Approached by Pulse, NHS England did not dispute the LMCs’ information. However the commissioner explained on background that expectations on response times have not changed – stressing that the contract set out that a patient should know on the same day how their issue will be managed by the practice, by arranging an appointment on another day, or signposting to an appropriate service.

However, it clarified that automated messages without active triage do not meet the appropriate response requirements and that blanket diverts to other NHS settings would not be an appropriate response.

A message shared by LMCs, including Lancashire and Cumbria, said: ‘The expectations on response times have not changed from the existing expectations, as set out in the regulations which were imposed on the profession under the previous government, and which have been in place since April 2023.

‘Likewise with regards to opening hours of practices, subcontracting arrangements to cover practice education, or arrangements with local OOH organisations will remain and there is no change.’

A number of concerns also remain with the new contractual requirements coming in from 1 October.

Last week, 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 the contract variation notice appeared 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

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

Previously, in June, NHS England published an unfinished version of the patient charter, which it later said had been published in error.

Listen to the full interview with Dr Bramall on the new episode of the Pulse in Focus podcast here