GPs are not yet contractually obliged to offer a response to patients the first time they get in contact, the BMA has confirmed.
The union said that the new contractual requirement for GPs to offer a response to patients the first time they get in touch with their practice will not come into effect until signed off by Parliament.
Pulse understands that the publication of the new access requirement regulations is imminent, and the contract will be updated to make clear that patients ‘should be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice’ after NHS England imposed changes last month.
The BMA expressed concerns around the new requirement, saying it believes it ‘is not achievable for many practices with current resource and workforce.’
Now, in an update to practices, Dr Kieran Sharrock, GPC England acting chair, confirmed that the changes will not come into effect until laid before Parliament.
He said: ‘Note that changes on access to general practice services have not been laid before Parliament and ICBs will therefore not have sent contract variations to practices.
‘This means the changes have not yet come into effect. We will share further information on this imposed contractual change as soon as it is available.’
Meanwhile, the BMA has 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 guidance said: ‘Ensuring that patients are seen by the appropriate clinician in the right place and at the right time, supports good patient care and experience, reduces pressure on GP practices and allows GPs to spend their time where it is needed the most.
‘Care navigation and clinical triage allow practices to prioritise patients with the most urgent health needs, ensure they see the most appropriate clinician or are signposted to alternative services.’
The union said that triage systems can improve access to health services as practices can direct patients to the right service, free up GP time to ‘deal with more complex issues’ and reduce GP workload and pressure by ‘distributing and delegating tasks across the practice team.’
What the new BMA guidance says
The success of a triage system is practice dependent. The system should work for both practice staff and patients. Below we list the steps you can take to make your triage system work for clinicians.
Steps you should take:
- Ensure staff have enough time in their working day
This is so that they can assist patients in completing triage forms.
- Ensure high-quality information is collected
A good medical history is key, and practices should ensure that triage forms allow patients to clearly describe their symptoms or conditions.
- Consider your staffing capacity
Practices should consider whether any additional staffing is required to effectively carry out care navigation/triage and how to mitigate workforce shortages.
- Ensure an even distribution of practice workload
Tasks should be appropriately assigned to ensure staff are not overburdened.
- Engage all staff in the process
Communicating with all practice staff is crucial to discuss responsibilities, impact on practice workload, and reorganisation of tasks. Practices should consider the staff skills needed to deliver triage effectively.
- Introduce a clear and easy-to-follow triage flowchart
This is so that staff can distinguish between urgent and routine issues. Please see the examples we have provided.
- Provide training for staff
Thorough training should be provided so that care navigators feel confident in using the system. Care navigators should not be expected to make clinical decisions, but the aim is to empower them to book patients into the appropriate appointment slots. Staff training should include formal training on managing difficult conversations with patients. Guidelines such as those published by Medics for Life could be used to support decision making.
- Create a standardised script
This is for care navigators to follow.
- Consider resourcing
Thought should be given to investment in additional resources, (e.g., equipment, hardware, software) that may be needed.
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