GPs attending the BMA’s annual England LMCs conference this month will debate whether to push for regulatory changes that would allow hospital consultants to work in GP practices.
Delegates attending the virtual conference on 25 and 26 November will also debate motions on NHS 111, PCNs, advice and guidance (A&G) services and other workload dumping from secondary care.
A motion proposed by Cambridgeshire LMC said that the BMA’s GP Committee for England should explore changes to the performers’ list regulations with NHS England to ‘allow consultant staff to deliver care within general practice’.
This comes as ICSs could have the ‘potential to support the general practice workload crisis’, it added.
Another motion to be debated said the conference ‘demands that all direct NHS 111 bookings into NHS general practice are suspended’ where the practice has declared a ‘red alert’ or equivalent.
It also demanded that one and two hour dispositions from NHS 111 stop as ‘general practice is not an emergency service and cannot safely receive [them]’.
GP leaders will also debate whether GPC England should ‘refuse to negotiate’ new work or funding for PCNs or an extension of the DES contract beyond its current 2023 end date.
The motions said the conference ‘instructs GPC England to negotiate that PCN funding be moved into the core contract’ and to ‘ensure practices are able to easily withdraw from the DES in a straightforward way that will not destabilise the practice withdrawing, other local practices or the provision of patient services’.
The conference ‘believes that PCNs are a Trojan Horse and a failed project that was mis-sold to the profession’, it added.
It comes as GPs were last week given until 14 November to respond to a BMA ballot asking what action they are prepared to take against NHS England’s GP access plan – including withdrawing or ‘disengaging’ from the network DES.
Another motion called on the GPC to negotiate a ‘fee for service contract’, including item of service payments for core general practice work, to replace the current block contract and prevent the ‘slow death’ of GMS.
It also said that practices should be allowed to offer private services alongside NHS services ‘where such services are not commissioned by the NHS for delivery in a general practice setting’.
Meanwhile, LMCs will debate a motion calling on the GPC to ensure that GPs ‘cannot be mandated to use advice and guidance by commissioners or providers’.
‘GPs should be free to refer to a secondary care colleague when thought to be clinically necessary, without pre-referral interference’ and ‘if advice and guidance is used, then it is [to] be the role of secondary care, not general practice, to dispense the advice to patients and prescribe where appropriate’, it said.
Pulse revealed this week that an LMC has called for GP practices to be paid £12.50 per advice and guidance (A&G) episode to resource the extra workload.
NHS England has set a national target requiring GPs to use A&G for 12 out of 100 outpatient attendances by March next year.
Other motions to be debated at the conference include motions calling for:
- The GPC to negotiate a ‘nationally-funded hospital discharge review system’ to ‘prevent contractually inappropriate requests’ and reduce ‘inappropriate transfer of workload’
- The removal of ‘all mandates and incentives regarding online consultations’
- ‘No mandated limit’ on the number of general practice representatives on ICS boards.
Motions in full
CAMBRIDGESHIRE: That conference sees Integrated Care Systems as having the potential to support the general practice workload crisis so calls on GPC England to explore with NHSEI changes to the performers’ list regulations to allow consultant staff to deliver care within general practice.
AGENDA COMMITTEE TO BE PROPOSED BY DERBYSHIRE: That conference, with respect to NHS 111:
(i) believes that general practice is not an emergency service and cannot safely receive one / two hour dispositions from NHS 111 services and demands that these stop
(ii) recognises that it has become a conduit for patient flow, causing delays to ambulance services, A&E departments and NHS general practice for non-urgent issues
(iii) calls for its wholescale review so that protocols, staffing, and funding are fit for purpose
(iv) demands that all direct NHS 111 bookings into NHS general practice are suspended where an OPEL4 / Red alert (or equivalent) has been declared by the practice.
AGENDA COMMITTEE TO BE PROPOSED BY SOUTH STAFFORDSHIRE: That conference believes that PCNs are a Trojan Horse and a failed project which was mis-sold to the profession and:
(i) believes PCNs pose an existential threat to the independent contractor model
(ii) that the workload, staffing, estate, supervision and HR issues outweigh any benefit derived from ARRS
(iii) instructs GPC England to refuse to negotiate new work, funding for PCNs or an extension of the PCN contract beyond its 2023 end date
(iv) instructs GPC England to negotiate that PCN funding be moved into the core contract
(v) instructs GPC England to ensure practices are able to easily withdraw from the DES in a straightforward way that will not destabilise the practice withdrawing, other local practices or the provision of patient services.
AGENDA COMMITTEE TO BE PROPOSED BY EAST SUSSEX: That conference believes that GPC England is at risk of presiding and prevaricating over the slow death throes of GMS, and:
(i) believes that the current GMS block contract of funding for general practice is outdated and inadequate for the current healthcare environment
(ii) believes that the model of unrestricted workload for a fixed fee is a major disadvantage to general practice within the new ICS landscape
(iii) calls on GPC England to negotiate a fee for service contract, including item of service payments for core general practice work, rather than the current block contract
(iv) tasks GPC England with negotiating a contract that allows practices to offer private services alongside NHS services, where such services are not commissioned by the NHS for delivery in a general practice setting
(v) tasks GPC England with exploring alternative contractual models for general practice in a post-NHS world.
AGENDA COMMITTEE TO BE PROPOSED BY NOTTINGHAMSHIRE: That conference is concerned about a lack of cohesion between general practice and secondary care and calls on GPC England to ensure that:
(i) GPs cannot be mandated to use advice and guidance by commissioners or providers
(ii) GPs should be free to refer to a secondary care colleague when thought to be clinically necessary, without pre-referral interference
(iii) if advice and guidance is used, then it is be the role of secondary care, not general practice, to dispense the advice to patients and prescribe where appropriate.
SHEFFIELD: That conference recognises the negative impact that inappropriate transfer of workload from secondary care to primary care is having on GP morale and recruitment and calls on GPC England to negotiate with NHSEI for a nationally funded hospital discharge review system that will:
(i) prevent contractually inappropriate requests
(ii) help develop new discharge pathways appropriate to care in the community
(iii) include an educational element for all clinicians
(iv) create more clinical dialogue between primary and secondary care.
AGENDA COMMITTEE TO BE PROPOSED BY WIRRAL: That conference believes that GP practices should decide how they can provide the best service to their patients; the introduction of online consulting was inadequately planned and resourced, and:
(i) insists on proper evaluation of the workload, safety, cost and impact on health inequalities of these before any further roll out is implemented
(ii) directs GPC England to negotiate regulations that enshrine the rights of practices to choose which systems they use for their population
(iii) believes that online consulting should not be a part of the GMS contract
(iv) calls for the removal of all mandates and incentives regarding online consultations
(v) is concerned that the 21 / 22 PCN DES includes a target for number of e-consultations per practice and calls for this target should be scrapped.
AGENDA COMMITTEE TO BE PROPOSED BY WORCESTERSHIRE: That conference recognises that GP representation in the new Integrated Care Systems is unclear and variable and demands that GPC England negotiate with NHSEI that:
(i) all Integrated Care Systems should outline how they will enable LMCs to carry out their statutory role
(ii) there should be no mandated limit on the number of general practice representatives on both NHS and Place Boards and general practice alone should decide who represents them within an ICS
(iii) national funding for GPs roles in system and place leadership be made available
(iv) funding must be ring fenced for enhanced services that are currently commissioned from general practice through locally commissioned services
(v) where collaboration and streamlining of pathways involves work transferring to general practice from secondary care, funding and resource follows from funding previously aligned to secondary care budgets.