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GPC rejects new contractual obligation to follow-up NHS 111 patients

GP leaders have roundly rejected plans to force practices to see patients directed to them from the NHS 111 service, a BMJ investigation has found.

A BMJ investigation – published today – uncovered emails between senior NHS England officials revealing their intention to insert new clauses into GPs’ contracts, which would subject them to breach of contract notices if they failed to see or speak with patients diverted to them from NHS 111 call centres.

The investigation also revealed NHS England was considering a proposal to allow patients to book a GP appointment through NHS 111 as part of the drive to ease A&E pressures.

But one GPC negotiator told the BMJ they had strongly resisted any contractual change, warning they were already too overstretched to take patients from NHS 111 and would not accept being told they must deal with cases by lay call handlers.

The emails, obtained through a Freedom of Information request, revealed discussions involving NHS England chief operating officer Dr Barbara Hakin about reports of patients being told by NHS 111 call handlers to contact their GP, but not being able to get an appointment.

One email, dated 20 July, included the statement: ‘We want to put something in the contract that makes it clear that if a 111 caller (or any other health adviser) says [the patient] need[s] contact with GP in specific time, that GP will be in breach of contract if a GP doesn’t fulfil that though of course it could be by phone.’

Dr Peter Holden, lead GPC negotiator on 111, told the BMJ: ‘We’re already seeing 60 to 70 patients a day. We cannot do any more safely. We are absolutely saturated.’

He added: ‘We said quite clearly, there’s no way we are going to be told that we are obligated [to see patients sent via 111]. What we do is re-triage [patients] and decide what we’re going to do. But we are not going to have some lay operative working a computer programme telling us how to practice medicine. We’re not having it, end of.’

A spokesperson for NHS England told the journal GPs were required to ‘care for patients as necessary’ as part of their contractual terms.

The spokesperson said: ‘We are working with the BMA to consider a joint statement which ensures practices make sure they meet this obligation. This is vital if a patient has been triaged through the clinical algorithm and the practice can respond with appropriate and timely clinical response.’