Every GP practice in England will have to remain open from 8am to 6:30pm on Christmas Eve and New Year’s Eve following a ‘non-negotiable’ final decision by NHS England – despite previous indications that it had softened its stance.
In a letter sent on Monday to local area teams, NHS England’s primary care lead Dr David Geddes wrote that the body had concluded it was ‘not reasonable’ for GP practices to close within core hours ‘especially in the winter’. This included Christmas Eve and New Year’s Eve and this position was ‘non-negotiable’, he added, warning that practices which decided to close within core hours could be in breach of contract.
Dr Geddes said that it was ‘reasonable’ for patients to expect their GP surgeries to remain fully open on 24 December and 31 December, and said those days could be ‘the only opportunity’ for the working population to source their prescription medication.
Pulse originally reported at the end of October that NHS England local area teams had informed LMCs that GMS practices faced breach of contract notices if they failed to open for core hours on the two days.
GP leaders pointed out that practices have traditionally subcontracted services to out-of-hours providers in the afternoon as there is very little demand from patients. They argued that this fell within the contractual requirements to meet patients’ ‘reasonable needs’ – and last month it appeared as though NHS England had been ready to back down and rethink the unpopular guidance.
However, in his letter this week Dr Geddes cited a number of reasons why it was unreasonable for practices to close early on those two days, including: the risk of people going to A&E instead; the risk of patients overloading out-of-hours services; the fact that GP practices ‘cannot reasonably claim’ that a sub-contracted provider will provide the same service; and that even if patients are used to GPs being closed on Christmas and New Year’s Eve, it did not mean the services were not needed.
The letter read: ‘Patients are as influenced as staff by the custom of practice closure which should not be confused with “need”.’
‘Practices cannot reasonably claim that patients receive the same service from a sub-contracted provider as they receive from their own practice, unless provision has been made to provide access to a patient’s records. The afternoon of the 24th and 31st may provide the only opportunity for patients who are otherwise working to attend to collect prescription medication and review prior to the festive season.’
Dr Geddes said that NHS England was trying to promote the use of GP services and the idea that ‘A&E services are not the default’, which means patients will ‘expect to be treated within reasonable hours by their own practice’.
The letter concluded: ‘So whilst we recognise that the GMS contract allows for the “provision of essential services at such times, within core hours, as are appropriate to meet the reasonable needs of its patients, and to have in place arrangements for its patients to access such services throughout the core hours in case of emergency”; we do not believe that closing early on these days amounts to “reasonable” for the reasons listed above.’
‘[I]t is our assertion that to not be available for the core hours especially in the winter is not acceptable and we object on the ground that the sub-contractor would be unable to meet the contractor’s obligations under the contract – ie not be able to deliver the full range of essental medical services during core hours – again for the above reasons.’
Dr Bob Morley, Birmingham LMC executive secretary and a member of the GPC, said: ‘We fundamentally disagree. We believe that if practices follow our guidance they are not in breach of contract – indeed we believe NHS England would not be able to give valid reasons for refusing early closure therefore would themselves be acting ultra vires.’
‘Needless to say GPC continues to disagree and has issued updated advice to practices.’
However, Wessex LMCs chief executive Dr Nigel Watson said that there had been negotiation on the issue. He said: ‘I think there is still confusion as to what the regulations permit and what NHS England are saying. [We have] largely reached sensible outcomes locally.’
Dr Geddes’ own surgery, the Clifton Medical Practice in York, announced on its NHS Choices page that ‘during the Christmas and New Year period the late surgery will be replaced with early morning surgeries on Tuesday 24 December and Tuesday 31 December.’
However the practice confirmed to Pulse that the only change was to its extended hours late surgery and that it would remain open within core hours.
How NHS England plans to enforce keeping practices open
The letter from Dr David Geddes says:
Whilst we recognise that the GMC contract allows for the ‘provision of essential services at such times, within core hours, as are appropriate to meet the reasonable needs of its patients, and to have in place arrangements for its patients to access such services throughout the core hours in case of emergency’; we do not believe that closing early on these days amounts to ‘reasonable’ for the reasons listed above.
Paragraph 69 of Schedule 6 of the contract regulations provides for a practice to notify NHS England of their proposal to sub-contract and provides at paragraph 69(5) of Schedule 6 for NHS England to object to the proposal; it is our assertion that to not be available for core hours especially in the winter is not acceptable and we object on the grounds that ‘the sub-contractor would be unable to meet the Contractor’s obligations under the Contract (ie not be able to deliver the full range of essential medical services during core hours’ again for the above reasons.
Read the full letter here.