Exclusive NHS England does not accept ‘arbitrary’ BMA advice for practices to redirect workload after 25 daily contacts per GP, Pulse has been told.
Under the 2023/24 GP contract, practices are contractually obliged to offer an ‘appropriate response’ to patients the first time they get in contact, and subsequent NHS England guidance said that they can only divert patients to 111 in ‘exceptional circumstances’.
Following the publication of this guidance, the BMA said GPs should redirect workload after 25 contacts in a single day. NHS England has previously declined to comment on whether exceeding these contacts constitutes ‘exceptional circumstances’.
However, in an interview with Pulse last week, national primary care director Dr Amanda Doyle said NHS England:
- finds BMA’s 25 contact limit ‘arbitrary’
- does not accept routine diversion to 111
- accepts staff sickness or unusual levels of demand as ‘exceptional’ incidences
- expects GPs to inform their ICB before redirecting patients to 111.
Pulse asked Dr Doyle whether the exceptional circumstances referred to by the commissioner included breaching the BMA’s ‘safe level of contacts’ number of 25 per day.
In response, Dr Doyle called the 25 contacts number ‘arbitrary’ and went some way towards clarifying in which circumstances GP practices could redirect patients to 111 without risking a contract breach.
She told Pulse: ‘What we have said is that we don’t want practices routinely when they are open diverting patients to 111. Part of the reason for that is that 111 is a triage and assessment service to patients go through a clinical algorithm on the phone and the outcome for half of 111 contacts is “contact your GP”.
‘But in the situation where suddenly there is an issue with the practice, people might go off sick or suddenly there’s a huge demand or something happens and they cannot deliver a same-day service in the way they would normally want to, then it’s perfectly acceptable to contact your ICB.
‘And in that specific circumstance [they can] divert patients to 111. But what we have said to practices, if you are in a position where you feel you need to divert your patients to 111, then you need to let your commissioner know. And that’s completely and utterly separate from any arbitrary number of contacts.’
Dr Doyle also clarified the now-contractual demand on practices to offer an ‘appropriate response’ to patients the first time they get in contact, by offering them an appointment or redirection, rather than asking them to call back at a different time.
She said: ‘It is not about seeing everybody first time they phone up. But what I consider to be completely unacceptable is patients hanging on the phone 45 minutes in the morning only to get through and be told they have to ring back tomorrow.
‘So we are saying our ambition is for the future – and we recognise that practices are struggling to deliver it now – but our ambition is that everyone with an urgent clinical need is assessed within the same day that they contact and routine requests for appointment are offered within two weeks.’
Dr Doyle mitigated this by saying that she knows and accepts that practices are currently struggling to fulfil that request. However, no one should ‘repeatedly’ be told to call back another day, she said.
She added: ‘I know that lots of practices have huge difficulty doing that now because demand is high and they’re struggling capacity. And I accept that. What I don’t accept is telling somebody is repeatedly trying to call to ring back tomorrow.
‘The requirements in the contract is about making it clear to someone what arrangements have been made for their care, the first time they come.’
Also in last week’s exclusive Pulse interview, Dr Doyle said NHS England is ‘not in a position’ to negotiate to a new five-year GP contract due a lack of funding commitment, with the 2024/25 contract set to be a ‘stepping stone’.
Pulse exclusively revealed two weeks ago that NHS England will work towards incorporating general practice in the ‘OPEL’ system pressures framework over the next year, while in the short term it expect ICSs to have tools in place to understand primary care pressures.
This would be equivalent to OPEL level 4 in hospitals – a situation when pressure means organisations are unable to deliver comprehensive care and patient safety may be compromised.
Currently, 40 LMCs led by Devon LMC are collecting GPAS data from their practices and 20 more are rolling out the system, with the first national report published at the beginning of July.
This revealed 60% of GP practices were reporting red or black alerts, indicating unsustainable pressure, while 80% reported patient contacts at roughly double the levels general practice is funded to deliver.
Dr Katie Bramall-Stainer, chair of the BMA’s GP Committee for England, said: ‘The BMA’s Safe Working Guidance was published earlier this year due to compelling evidence from GPs telling us how they were attempting to keep up with spiralling workloads.
‘Making too many patient contacts in one day is unsafe. It threatens safe patient care and can lead to professional burnout with fewer GPs working in the NHS as a result. In fact, we’ve lost the equivalent of more than 2,200 full-time, fully-qualified GPs since 2015, and a single full-time GP is now responsible for an average of 2,304 patients.
‘The BMA was compelled to issue this guidance because of the unsustainable pressures facing general practice and because, without extra funding or resource to keep up with this demand, GPs need help in keeping their heads above water and embedding measures to protect the wellbeing of their practice staff.
‘At a time when GPs are leaving the NHS in their droves, the BMA shouldn’t need to publish such guidance. Sadly, without resourcing general practice we’re not left with many alternatives to providing safe patient care. We have repeatedly said that a long-term solution is needed, and we would welcome working with NHS England and the Government to find a way to do that.’