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New contract does not mean GPs ‘have to offer appointment’ on first contact

New contract does not mean GPs ‘have to offer appointment’ on first contact

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, the GPC has said.

NHS England has imposed a contract this month with a focus on access, and the imposition has led to talk of potential industrial action, with GPC England convening a special meeting on 27 April to discuss next steps.

The contract papers for the Network DES were released this morning, although the details around the GMS contract have still not been published as of Thursday 30 March, despite it being implemented from 1 April.

The papers released today said: ‘The GP contract in 2023/24 has been updated to reflect the different ways that patients now contact their practice whether this in person, online or by telephone.

‘Patients will be treated equitably and can expect a response on the same day they contact their practice.’

Speaking at a webinar earlier today, Dr Clare Bannon, a member of the GPC executive, clarified that the ‘response’ does not necessarily mean offering an appointment, but it includes signposting to other services, including 111.

She said: ‘The GMS regulation changes require us to do something with patients the first time they contact us, so that may be signposting, that may be offering an appointment. But it does not mean it has to be offering an appointment – there is a range of different dispositions, and what we are saying to practices is that they really need to think about what they do with those patients.

‘We’ve talked extensively over the last few months around safe working and I would encourage people to look at the safe working guidance because we really should be making sure we are not having more than 25 appointments a day – we know it adds to stress and increases the risk of burnout.

‘For patients that call up, we need to think about how we signpost them – signposting to 111 is okay, as is signposting to the pharmacy service and signposting to self-referral schemes.’

She also said that it was made ‘very clear’ in the regulations that the response does not have to be face to face, but done with ‘the right method.’

Dr Bannon said: ‘It does not mean we have to see our patients – if the right thing for the patient is to signpost them, ask them to self-care, to refer them to the community pharmacy scheme, then that’s what we should be doing.

‘But if you feel the patient needs to speak to a doctor that could be by telephone, video consultation or face to face.’

The Network DES capacity and access payment guidance published today also mentioned ‘signposting’ and that ‘patients seeking routine care should have an appointment within two weeks of contact where appropriate.’

Dr Bannon explained that providing a response on the same day is a change in regulation, while the fact that patients seeking routine care should be offered an appointment within two weeks is ‘purely a target.’

She added: ‘[The first] is a change in the GMS regulations so just like anything that is in the GMS regulations – when we decide whether to see a patient, as we do now, that hasn’t changed.

‘If it’s appropriate to see a patient when we speak to them, then we would see the patient.

‘If we deem it’s appropriate to signpost a patient somewhere else, then we should be speaking to them and as long as they are in agreement, then it’s a negotiation, just like it is now, when we decide to do home visits or ask a patient to come to surgery. It will very much work in the same way.

‘If we don’t meet that requirement, we could risk a breach of contract, it’s not getting us to a target – there will be no measurement of this, it will be a question of if someone raised concerns that as a practice you weren’t doing this and you weren’t signposting appropriately.

‘The two-week target is not just GP appointments, it does include other appointments but we need to be really clear that this comes back to how you arrange your appointment book and the appointment category.

‘I know everyone went through a process of matching their appointments to the seven different appointment categories and this is really important.’

Further guidance on access will be published by the BMA in the upcoming weeks.  

GPC officials also confirmed that the new contract does not stipulate that GPs must agree death certificates with a medical examiner, updated GPs on potential options for industrial action and advised them to stick to ‘safe working guidance’ in order to prioritise patients and ‘avoid burnout’.



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

Just My Opinion 30 March, 2023 5:17 pm

GPC – Please make it crystal clear to NHSE that to meet these targets practices will:
1. Block appointments so booking more than 2 weeks in advance is impossible.
2. Send all patients to A+E once we run out of appointments as a result of that.

If we send them to pharmacies or 111 they will just bounce straight back to us with unrealistic expectations, so this is not an option.

Douglas Callow 30 March, 2023 5:20 pm

stitched up like a kipper by allowing a contract imposition clause
the fun begins….

David Church 30 March, 2023 6:49 pm

So, if the patient contacts the surgery and requests an appointment for a blood sample in 3 months’ time, the staff must make a ‘response’, which can be ‘No.’ ?
That seems to fit the requirement to not ask them to call nearer the time.
And for most other things, it does seem that government is intent on using the ‘divide and conquer’ principle of allowing that all we have to do is ‘signpost’ everyone to A&E. I am sure AE doctors will like that. There again, it could be useful for providing junior doctors with experience of GP type problems, like side effects, messed-up repeats, interactions, and monitoring requirements, which will be hard to find in actual GP surgeries once all the Trainers have retired to damp down their burnout.
Taking the patients’ side for a moment, though, I have no sympathy for any surgery where a patient can phone in on 4 successive mornings to be told ‘there is no doctor here today – phone before 0840 (but after 0830) tomorrow’ when their problem could be sorted over the phone if only Reception would take a message and pass it on in the right direction for a call-back later. Yes, such practices do exist.

Anila Qureshi 30 March, 2023 6:57 pm

Fantastic idea ! – excessive demand , no staff , declining gp numbers.. but just push the expectation higher of the general public .. receipe for disaster

SUBHASH BHATT 30 March, 2023 7:37 pm

I think gps need to think from patient’s Perspective. There is no excessive demand ,as no one want to contact gp unless needed. Nhs 111 was (recently) in my experience was a waste of time.
No reason why a practice can’t guide patient on first contact. No staff ,
is not patient’s problem…

Richard Greenway 30 March, 2023 8:26 pm

No they just don’t get it.

1. There’s an access problem, because they have failed to recruit and retain GPs.
2. GP numbers have threfore dropped.
2. The population is rising, and aging, and more treatments are available. Demand is therefore rising.

Being LESS prescriptive and allowing more professionalism might just aid retention a bit. Doing the opposite by increasing demand /pressure / expectation with crazy schemes just creates more GP loss which just makes it all worse.
But perhaps that’s the idea.

Anonymous 30 March, 2023 9:58 pm

2 noctors will be employed for the price of 1 GP.

David jenkins 31 March, 2023 12:48 am

Richard Greenway

it seems to me it is not the elderly who are banging the drum………………..

it is the younger, stroppier, more demanding, usually the worried well “my wife says i have a mole on my back which i can’t see, and she wants it checked out” who are the cause of the problem.

not really a problem for me………………….so long as you accept that if i am “checking out” this mole you have had for years, your mother, who has had rectal bleeding, will have to wait to be seen.

you’re paying for it – you decide how to use it.

but don’t complain when the shop door (for that it is what has become, through no fault of ours), closes at 6.30.

Hewa Vitarana 31 March, 2023 6:41 am

Dear GPC Colleagues.
Please get the answers to the following two simple questions.
1 How many appointments per month or year per person?
2 How much money do you get to provide the service?

Andrew Jackson 31 March, 2023 8:53 am

The Government is trying to solve the electorally unpopular situation of the 8 am rush and then a proportion being told to ring back tomorrow as all the appointments have gone.
This can’t be policed by data gathering at a practice level so i’m suspecting it will be policed by publicising the contractual right to be assessed to patients and letting them become the enforcers.
It will also mean many patients will not bother ringing at 8am as they have a right to be triaged at any time of core hours.
Many of us can handle triage in the morning but have no systems to manage this throughout core hours.
If enough patients enforce verbally it will become an adversarial nightmare.
Are we really expected to employ clinicians to be available to triage every contact as it arrives?
The only practical response is to recommend A and E /111 for the overflow.
We need a standard BMA letter to answer the complaint of ‘you didn’t assess me at first contact’
There has to be an assessment of the number of GP (and ARRS) appointments that are available to the NHS in a safe and sustainable way annually based on GP numbers and then a decision on what health presentations this should be allocated to. Clearly great swathes of work will need to be dropped until staff numbers improve and this is likely to be much of the high NNT preventative work we do around BP/cholesterol/ pointless annual medication reviews etc
There is again more money for access but the money doesn’t help: we have not enough staff, not enough rooms.
The next contract is about setting a line that no GP will see more than 25 patients in a day (2 sessions of 12 patients at 15 minutes with 1 visit max). Every GP should have funded CPD and QI time.
Then we may have a viable option for a F/T GP career instead of this career impossible survival state the profession is in.

Dr No 31 March, 2023 10:00 am

An assessment/appropriate signposting means clinical triage. I nearly left GP in 2015 due to starting work with 90 phone calls to complete plus the day’s booked appts. We limited to 35 contacts per GP and that felt daring, Work became do-able for a long time. Now all the advice is 25 per day, and the government are giving patients right to triage on contact, essentially.

Obv this isn’t going to happen so the only “safe” option in lieu of primary care triage will be to direct to A+E. 111 is a nonstarter. That’s a feedback loop that ends back at your door, 24hrs later with a sicker patient.

Wendy Kitching 31 March, 2023 12:19 pm

As far as I understand it we are being asked to assess patient ‘need’ at first point of contact not their ‘want’. Our receptionists already do this very carefully . Routine GP appts booked in advance if requested or on the day if we still have capacity , urgent booked on the day with the on call GP if we still have capacity . Capacity for us is now 25 per day each . Beyond this, routine are signposted to self care/pharmacy/walk in centre/111/extended access . Urgent are signposted to walk in/111/A&E depending on the problem .
The only change i foresee us having to make with the new contract is blocking all routine appointments beyond 2 weeks ( meaning more signposted as above) and probably having to enter some sort of code into every medical record after every phone contact saying ‘need assessed ‘
The powers that be seem to make odd assumptions that we did not already have the sense to assess patients need to ensure they got safe care somewhere if we couldn’t provide it ourselves