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GP practices threatened with contract breach notices for closing at lunchtime

GP practices threatened with contract breach notices for closing at lunchtime

An integrated care board (ICB) has threatened local GP practices with contract breach notices for closing over lunchtime.

Kent and Medway ICB sent a bulletin to practices last month, seen by Pulse, stating that there had ‘been recent media coverage of practices closing at lunchtime and it will continue to be a subject of interest’.

The bulletin said it ‘may be necessary for the ICB to issue the practice with a remedial breach notice’ if there was no evidence of approval from commissioners.

The LMC is challenging the contractual basis for any such breach notices.

The ICB bulletin said: ‘As you are aware, closing at lunchtime is not permitted. 

‘While Kent and Medway Integrated Care Board (ICB) fully appreciates that practices are faced with staffing pressures, doors are required to remain open to patients between 8am to 6.30pm, Monday to Friday.’

It added: ‘If it is identified that a practice is closing without commissioning approval then it may be necessary for the ICB to issue the practice with a remedial breach notice, if the practice is unable to provide evidence of commissioning approval and that the closure meets the reasonable access needs of their patient population.’

One local news story published by Kent Live last month reported that ‘thousands’ of Kent patients are left ‘seriously disadvantaged’ because they cannot contact surgeries that are ‘shut for lunch’.

A spokesperson for Kent LMC said it has ‘asked the ICB to clarify the contractual basis for their statement’.

In an email bulletin shared with local practices last week, the LMC said that GPs should refer to BMA guidance on GP access ‘in the meantime’.

NHS England said it would crack down on GP practices which closed for half days back in 2019, however the BMA says there is no contractual requirement for GPs to be open ‘at all times’ during their core hours (see box).

BMA guidance on lunchtime closures

The BMA guidance set out that while GMS regulations ‘define core hours as 8am to 6.30pm Monday to Friday (excluding bank holidays)’, they ‘do not require practices to be open at all times during core hours’.

It added that GMS regulations also do not require practices to ‘deliver all services at all times when they are open’.

However, GP practices are contractually required to ‘provide services at times that are appropriate to meet the needs of patients’ – either themselves or through subcontracting arrangements – it said.

And they must ‘ensure arrangements are in place for patients to access services throughout core hours in case of emergency’, allowing ‘practices to close, for example, to undertake training or staff reviews’, it added.

The BMA said: ‘In summary, the GMS regulations allow individual practices to decide which services to provide when, to meet the needs of their patients.

‘Practices should be able to show they have engaged with their PPG (patient participation group) to check the arrangements are meeting their reasonable needs, and are addressing any areas of concern (within the regulations regarding PPGs).’

GP practices that are ‘challenged’ by their local commissioner because it believes their hours are not meeting the ‘reasonable needs’ of their patients should provide it with information showing this is not the case, the BMA added.

This should include evidence that the times of delivering services meet the reasonable needs of patients, there are arrangements so that patients can access services in an emergency outside of these hours and the practice has engaged with patients around hours.

It said: ‘If the commissioner serves a breach notice as it believes you are not meeting the reasonable needs of your patients, the onus under the regulations is on the commissioner to evidence that claim as part of the breach notice.

‘If your commissioner approaches you regarding the reasonable needs of your patients and produces NHS England guidance as evidence, we advise that you inform the commissioner this guidance is not a contractual requirement.’

GP practices in this situation should also contact the BMA GP Committee and their LMC, it added.

A spokesperson for NHS Kent and Medway said: ‘We are aware a small number of practices have been closing their doors at lunchtime and we have made very clear to them that patients should be able to access GP services between 8am and 6.30pm, their core contractual hours. 

‘We understand the enormous pressure general practice is under and we are happy to work with practices on how best to meet local patient demand.’ 

In May, local GP leaders debated changing core working hours to 9am to 5pm but ultimately voted against the move following a lively debate at the UK LMCs Conference in York.

However, GP representatives voted in favour of the BMA GP Committee ‘renegotiat[ing] the GMS contracts with workload limits in order to protect all general practice staff and patients’.

Meanwhile, NHS England recently said that ICBs or GP networks should consider paid advertising to promote new enhanced access on weekend and evenings ‘if budget is available’.

Starting from this month, PCNs need to provide enhanced service access from 6:30pm to 8pm on weekdays and 9am to 5pm on Saturdays.


          

READERS' COMMENTS [9]

Please note, only GPs are permitted to add comments to articles

David Church 25 October, 2022 10:08 am

what about the one that closes at 11 am Tuesday and isn’t open again until Wednesday at 9am? (Not in Kent).
Ours was told by LHB we must have the doors open for patients to walk in from 8 am to 18:30 and a doctor on the premisses at all times.
it is completely unfair.

David jenkins 25 October, 2022 11:11 am

David Church

i don’t think the doctor has to be physically on the premises – only “available”

that was certainly the case when i resigned from my rural, single handed, dispensing, high earning, practice (in the same LHB as you) in 2007.

SUBHASH BHATT 25 October, 2022 11:30 am

Doctor can’t be available all the time in single handed practice. Who will do home visits.
Telephone service are always available even if half day and cover offered by other agencies .

Adam Crowther 25 October, 2022 1:26 pm

If telephones are on and the online consultation software is operational then the practice is not closed!🤷🏻‍♂️

Patrufini Duffy 25 October, 2022 3:56 pm

Leave the telephone line on. There’s a wait for 1 hour. Just like with a hospital department. Go away. Look after yourself.

Patrufini Duffy 25 October, 2022 3:57 pm

I know many NHS dentists that are shut, for months.

Fedup GP 25 October, 2022 4:32 pm

….please do keep the beatings coming – its doing wonders for morale and retention

Patrufini Duffy 25 October, 2022 8:17 pm

The last time I checked, half the ICB board job lot are sitting at home, on a zoom call, at 3pm, feeding the dog, and checking some bullet point document box stuff whatever, while knocking offline for a bit to go shopping and eating a chilled out lunch. No? Cosy isn’t it, far from the public steam.

Dave Haddock 26 October, 2022 11:27 am

Consequence of the absurd funding system for GP, where you earn more money by doing less. Reduce your clinical sessions and Practice income remains the same; spend the time on one of those pointless PCN jobs and income goes up.
Incentives are all wrong, and playing whack-a-mole merely wastes everyone’s time.