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.
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.
‘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:
- 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.
- 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.
- 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.
- 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.