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GP practices receiving hundreds of breach notices from ‘punitive’ NHS managers

Exclusive NHS managers are issuing hundreds of contract breach notices to GP practices a year, with GP leaders warning some are ‘too ready to take punitive action’, Pulse has learned.

Pulse has obtained figures revealing that NHS England has issued close to 300 breach-of-contract notices to GP practices since it was set up in 2013.

Its reasons for doing so range from offences such as failure to supply e-declarations on time and closing early on Christmas Eve, to one GP who received a notice for closing for a day due to burnout.  

In one areas, 108 practices were hit with a breach notice in a single year for failures relating to ‘patient record transfers’.

GP leaders said local area teams are using breach notices to ‘as a stick to beat’ struggling practices.

But NHS England said it is issuing the notices to ‘ensure that patients receive the best service possible’.

A Pulse Freedom of Information (FOI) request to NHS England revealed that 282 breach notices were served between April 2013 and April 2015.

Pulse was unable to secure details about the numbers of notices given out by PCTs before them, but local GP leaders said this is an increase on previous years.

Examples of breach notices being issued included:

Londonwide LMCs medical director Dr Tony Grewal says there is ‘no question’ there is an increase in the use of breach notices, and he has seen one for ‘keeping the nurse’s sandwiches in the vaccines fridge’.

He said: ‘NHS England doesn’t have the capacity, and some might say doesn’t have the will, to support practices that are not up to scratch. And just issuing a breach notice seems to be the norm.

‘The main problem we are seeing in our region is lack of support for practices that are struggling. A breach notice is not a support tool, it is a whip. So what I would like to see is NHS England offering support to practices rather than beating them with a stick.’

Pulse’s FOI request revealed that, in the West Midlands, 108 breach notices were issued in 2013/14. NHS England confirmed this figure was correct, and added: ‘No practices were closed as a result and the majority of these notices were related to patient record transfers.’

However, the spokesperson refused to provide any further details.

Breach notice box - online

GPC deputy chair Dr Richard Vautrey said the overall number remains relatively low, reflecting the quality offered by practices.

However, he added: ‘There is significant variation between regions, suggesting some are too ready to take punitive action. It’s always better to work with a practice in a supportive way rather than taking a punitive approach.’

An NHS England spokesperson said: ‘NHS England will always do everything it can to ensure patients receive the best service possible, including the issuing of breach notices.

‘There are a wide range of circumstances that can lead to the issuing of such notices and so the number is likely to vary year by year.’

Fact file: Contract breaches

NHS England can issue either a ‘breach’ or a ‘remedial breach’ to practices, as a result of:

• Failure to deliver the contract in relation to mandatory or locally agreed clauses.

• Behaviour that gives cause for concern, which may (or may not) lead to a failure to deliver a contract.

A remedial breach notice is issued to a GP practice when NHS England determines it is capable of remedy and informs the practice what it is expected to do to remedy the breach.

For example, NHS England says ‘a contractor may not have a practice leaflet’ required by the contract.

NHS England issues a breach notice when it deems a breach cannot be remedied, instead requiring the practice not to repeat the breach. An example is a practice being ‘closed during core hours [with] no access for registered patients to essential services throughout the closure’.

A practice wishing to appeal a breach notice has 28 days to do so.

Source: NHS England