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Many GPs will not be able to offer patients response at first contact, BMA warns

Many GPs will not be able to offer patients response at first contact, BMA warns

Many GP practices ‘will not achieve’ the new contractual requirement to offer a response to patients the first time they get in contact, the BMA has warned.

The GP 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, triggering potential industrial action.

At the end of last month, the GPCE made clear that the new contractual ban on asking patients to call back at a different time will not mean having to offer them an appointment on first contact.

Now the union has published detailed guidance on the new requirement, saying it believes it ‘is not achievable for many practices with current resource and workforce.’

The BMA guidance, published today, said: ‘Though we may agree with the aspiration of this amended regulation, GPCE believes that this requirement is not achievable for many practices with current resource and workforce.

‘With GPs numbers decreasing, consultation numbers higher than ever, and general practice being under-resourced, we think this government-imposed contract will push GPs and practices to the brink of their existence, within the NHS. For this and other reasons GPCE rejected the contract changes.’

The contract will be updated to say that the decision regarding providing an appointment or to signpost must ‘be based on the clinical needs of the patient’, but the BMA warned that many practices will struggle to provide this.

It said: ‘Some practices may be able to achieve this requirement as a function of having adequate care navigation capacity or by utilising total-triage systems, however, many practices will not be able to do this as demand outstrips capacity.

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‘Many practices do not have enough adequately trained care navigators or other clinicians to make this assessment of clinical need.’

The GPCE sees the use of care navigation ‘as a potential solution’ to this imposed contract stipulation, but practices ‘may have other innovative ways of managing this issue’, such as total triage.

However, the BMA do not advocate a move back to duty doctor or other systems which place an ‘unnecessary and unsafe burden’ on GPs.

Practices where care navigation is used to allocate patients to ‘appropriate services’ have various possible dispositions for patients who contact the practice, according to the guidance:

  • offer on-the-day assessment by another clinician for cases perceived to be urgent
  • offer assessment at another time by a clinician for cases relating to longer-term and non-urgent conditions
  • signpost to another service where another service is appropriate e.g. mental health support, community services, community pharmacy
  • signpost to 111, UTC, overflow hub when capacity in the practice is reached
  • Request further information – for example via digital tools available to surgeries.

What the regulations say

Contact with the practice

The regulations will now say:

  1. The contractor must take steps to ensure that a patient who contacts the contractor by any of the following means is provided with an appropriate response in accordance with the sub-paragraphs 2- 4 below.
  • (a) by attendance at the contractor’s practice premises
  • (b) by telephone
  • (c) through the practice’s online consultation system or
  • (d) through any other available online system.
  1. The appropriate responses the contractor must are:
  • (a) invite the patient for an appointment, either to attend the contractor’s practice premises or to participate in a telephone or video consultation, at a time which is appropriate and reasonable having regard to all the circumstances
  • (b) provide appropriate advice or care to the patient by another method
  • (c) invite the patient to make use of, or direct the patient towards, appropriate services which are available to the patient, including services which the patient may access themselves.
  • (d) communicate with the patient:
    • to request further information
    • to convey when and how the patient will receive further information on the services that may be provided to them, having regard to the urgency of their clinical needs and other relevant circumstances.
  1. The appropriate response must be provided:
  • (a) if the contact under sub-paragraph (1) is made outside core hours or during the following core hours.
  • (b) in any other case, during the surgery period in which that contact is made.
  1. The appropriate response must:
  • (a) not jeopardise the patient’s health.
  • (b) be based on the clinical needs of the patient.
  • (c) take into account the preferences of the patient where appropriate.


          

READERS' COMMENTS [9]

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

Some" Bloke 6 April, 2023 1:20 pm

Message to public needs to be plain and clear: we have rejected these( imposed changes)

David Church 6 April, 2023 1:27 pm

GP ‘Receptionists’ used to be excellent at managing care navigation and demand, but appear to have been de-skilled (or just had the options removed ffrom them!) by the directive to give a same-day physical appointment to everyone until the supply runs out, and then call back tomorrow.
This has not helped patients, GPs, or demand on receptionists/telephonists.
What is needed is a return to the original ‘manage it how you feel is best’ of old-style GP surgeries, but the new and unhelpful telephone response options may now be too entrenched.
Expectations have been changed and misleadingly raised so often, that nobody is happy with the outcoem any more.

Darren Tymens 6 April, 2023 1:48 pm

At a stroke the nature of general practice has been changed without negotiation.
We have never been an ‘urgent care’ service, not a triage service.
Urgent care is delivered by WICs, MIUs, A&Es.
Triage has been delivered by 111.
There has been some obvious overlap. We see around 45% as ‘same day’ because it is, by and large, a reasonable and efficient use of resources, and we are committed to offering the best service possible to our patients.
Conceptually, I don’t have a big problem with this *BUT* if they want a front-of-house total triage service they should fund it at (at least) the same rate as 111 is funded per contact; and if they want us to use capacity to deal with more if the urgent workload each contact should be funded at the same rate as an urgent care contact. That way we could build capacity to match the demand for access.
But no: they expect us to do it for free.
Until they find the change and the workload properly we should say ‘no’. In the meantime, I suggest business as usual and refer everything you can’t manage within safe workload limits to 111 or A&E.

Turn out The Lights 6 April, 2023 2:11 pm

Spot On Darren.

Dr N 6 April, 2023 3:12 pm

Easy. Let’s turn the clock back 20 years and have five minute appointments

Dr No 6 April, 2023 11:24 pm

Oh look this is easy, don’t know why y’all worried. Look!:

1 (b) Receptions tells patient there are no appointments, by telephone.

4(a and b) since clinical triage is essentially an appointment, and there are none of those (already established), then the clinical needs of the SU are not assessable. Therefore we must assume they are immediate and very serious. A very reasonable fail-safe option. Therefore:-

2(c) The SU is invited to use of the local A+E department.

Presto. Problem solved.

Anonymous 7 April, 2023 5:09 pm

220 patients waiting in my local ED last night with all neighbouring EDs on divert as well.
This is the first night before a long 10 day stretch of skeleton medical staff.

Mei-Ling Lancashire 27 April, 2023 4:08 pm

Given that BMA GPC have voted no to industrial action. How’s about we all just agree that we won’t do it. Whilst the plans are afoot to remove the contract and turn us into a healthcare McD’s drive thru, they’re not going to be able to hold us all in breach of contract. And yes I’ll have a McFlurry to go.

SUBHASH BHATT 27 April, 2023 5:49 pm

I see no problem with this at all. Primary care is first point of contact even if it is urgent . How you deal with is your problem. Sending patient to an and e seem to have easy option which was not there in past . .