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GPs will divert ‘large numbers to A&E’ due to contract change, LMC warns

GPs will divert ‘large numbers to A&E’ due to contract change, LMC warns

Changes around access requirements for practices will result in GPs diverting ‘extremely large numbers of patients’ to 111 and A&E for fear of being held in contract breach, an LMC has warned.

From 15 May, GPs will be contractually obliged to offer an ‘appropriate response’ to patients the first time they get in contact, which will include ‘communicating with the patient’ or directing them to appropriate services.

The new regulations also said that the response must ‘where appropriate, take into account the preferences of the patient’ and ‘must not jeopardise the patient’s health.’

However, in new guidance distributed to practices, Berkshire, Buckinghamshire and Oxfordshire LMCs said the meaning of this clause is ‘unclear’, ‘illogical’ and ‘essentially useless’, and will cause confusion around what represents a breach of contract.

The LMC’s guidance published today and seen by Pulse said: ‘This clause will likely result in practices diverting extremely large numbers of patients to 111 and A&E for fear of being held in contract breach, due to the unclear meaning of this clause.

‘This is an illogical clause which is so broad in its definition as to be essentially useless. As “jeopardise” is not defined, nor is what aspect of the patient’s “health” then it is questionable how it should be interpreted.

‘Obviously, if a response is “appropriate” it would not “jeopardise the patient’s health” – the clause makes no sense.

‘Taken literally this clause forces the practice to direct the patient to another in the interests of patient safety if the practice is not able to meet the patient’s needs that day, or if it is not possible to guarantee their health will not be “jeopardised” by delaying their consultation/request to a later date.’

The LMC said they had been contacted by practices asking for advice on the implications of the contract imposition in the context of ‘increasing demand and diminished workforce.’

The LMC’s guidance to practices added: ‘Of particular concern, has been the suggestion that the contract prevents the practice from directing the patient to defer their contact to a later date or time due to unavailable capacity.

‘Practices may instead direct patients to other services, such as 111, Community Pharmacies, UTCs, or A&E.

‘This clause is helpful, as previously commissioners and practices have been unclear on the contractual basis for diverting patients to other services such as 111 once safe capacity limits have been breached.

‘Practices can now be reassured that they can cite this clause if their decision to divert patients to 111 is called into question.’  

The BMA expressed concerns around the new requirement, saying it believes it ‘is not achievable for many practices with current resource and workforce’ and also published new guidance on care navigation and triage, in order to help GPs signpost patients appropriately either within the practice or elsewhere.



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

Darren Tymens 20 April, 2023 7:23 pm

Previously, I might have squeezed them in when necessary, to keep patients safe and to keep the work out of A&E – but now this clause means I can happily divert them elsewhere once I am full. Hopefully the Brainiacs at NHSE have anticipated this problem and increased 111 and A&E capacity in advance of this? (please note that this is a rhetorical question)
Presumably this is what whoever wrote the clause intended? Or did they intend to kick us with it, only to discover that it can be interpreted both ways?

John Graham Munro 21 April, 2023 8:20 pm

Just do what you can in the time allotted, then close your doors and go home——other wise you will end up in the Gerada unit for ”distressed doctors” at the local ”’loony bin”

A Non 24 April, 2023 10:58 am

I think the next GP contact should honed down to a single sentence and say something like “GPs should provide an excellent service, whenever contacted by whoever wants it” . Keep it simple. Come down on them heavy if it isn’t good enough. There needs to be a unilateral re-write clause in an appendix somewhere, and obviously the contract sentence will have to be completely rewritten and totally overhauled every 6-8 months to keep it relevant and up to date and in line with the most recent government report by a dame/lady and/or lord.

James Weems 24 April, 2023 10:20 pm

Presumably we can now prevent 111 from
Direct booking into our surgeries if we are ‘full’?