NHS England will not enforce new face-to-face appointment guidance

Exclusive NHS England will not enforce its new guidance on face-to-face appointments, although CCGs may, Pulse has learned.

It comes as the promised updated standard operating procedure has finally been published, although it fails to clarify questions raised by NHS England’s previous guidance.

An NHS England spokesperson told Pulse that ‘local health groups will work with practices to make sure patients get the services they need’.

When pushed for further clarity, a spokesperson told Pulse on background that it is up to local commissioners to hold GP practices to account for delivery of their contract, but that CCGs have not specifically been asked to monitor or enforce the new guidance.

They added that NHS England is not aware of any threats of action against GPs who are unable to follow the letter’s guidance.

Last week, an NHS England letter sent to practices said patients must now be offered face-to-face appointments if that is their preference.

Both LMCs and the BMA have advised practices that the letter has ‘no contractual force’ and should be regarded as guidance only.

But it remained unclear whether this would be monitored or enforced by NHS England.

In a formal statement, NHS England said: ‘GPs have worked hard throughout the pandemic and are now  pulling out all the stops to roll out the biggest and fastest vaccination programme in NHS history – providing vital protection to millions of people. 

‘NHS guidance, which makes sure that patients can access face to face appointments, has been widely welcomed by patients and local health groups will work with practices to make sure patients get the services they need.’

It remains unclear whether CCGs will be supportive of practices that do not follow the guidance and whether NHS England will back any enforcement action commissioners decide to take.

However, in a blog published today, NHS England medical director for primary care Dr Nikki Kanani said: ‘As GP teams, working with patients, you are best placed to ensure the best balance for the communities you serve, and we will do all we can to support you through the most difficult time you have experienced.’

Meanwhile, NHS England also today published its updated GP standard operating procedure, promised in last Thursday’s letter to the profession.

However, the document is contradictory over what is expected of GPs.

All practices ‘must ensure they are offering a blended approach of both face to face and remote appointments, so both are always available to patients according to what is clinically appropriate’, it said.

However, it reiterated that practices must ‘respect [patient] preferences for face-to-face or remote care unless there are good clinical reasons to the contrary’, such as the presence of Covid symptoms.

It also said that practices should ‘continue to ensure that public health measures can be safely implemented’.

The document added: ‘To avoid queues and crowded waiting rooms, remote triage and patient navigation should be used wherever possible, with patient preference of triage and consultation mode taken into account.’

It remains unclear whether GPs can decline face-to-face appointments if not clinically necessary, or whether they must provide them to patients who want them unless there is a clinical reason not to.

It is also unclear whether an over-capacity waiting room is considered a ‘good clinical reason’ not to offer face-to-face appointments, in order to follow social distancing measures and protect patients and staff from infection.

Previously, NHS England told Pulse that if a patient is not deemed to be a clinical infection risk, they should be given a face-to-face appointment if they request it. 

The standard operating procedure also said that patients should be ‘treated consistently regardless of mode of access’.

It added: ‘Patients can be supported to complete a triage questionnaire by reception staff on the phone or face to face using the same process as patients that contact the practice via an online access route.’

It also said:

• GPs must ‘reach out to patients whose health needs may have increased, developed or gone unmet during the pandemic’
• GPs should ‘avoid unnecessary outpatient activity’
• Practices should ‘support staff wellbeing and recuperation’.

It comes as the BMA’s GP Committee has voted to pause all meetings with NHS England until the disagreement around face-to-face appointments in practices is resolved, saying it has ‘no confidence’ in NHS England’s executive directors.

It follows calls among grassroots GPs for the resignation of NHS England’s medical director for primary care amid the furore created by its letter – with a petition to that effect racking up over a thousand signatures so far.

Meanwhile, the BMA this week called for an ‘urgent meeting’ with the health secretary to seek clarity regarding face-to-face GP appointment advice.

And the RCGP has issued an updated response to NHS England’s letter requiring practices to offer face-to-face appointments to all who want them, amid criticism from GPs.