This site is intended for health professionals only


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.

READERS' COMMENTS [13]

Chin Whybrew 20 May, 2021 5:25 pm

“Patients should be able to make requests via an online system at any time” is probably going to cause some upset too…

“Practice receptions should be open to patients to ensure that those without easy access to phones or online services are not disadvantaged when accessing care. Physical access to practices should be consistent with infection prevention and control guidance; patients self-isolating due to COVID-19 should in no circumstances present to practices in person”. Ah yes, these two sentences are directly contradictory as well – I am sure we are not the only practice where self-isolating patients have come to the practice in person, and only told us when they actually arrived here that they were self isolating because “trips to seek medical care didn’t count”…

Darren Tymens 20 May, 2021 5:42 pm

I think the headline should read
‘NHS England CAN’T enforce new face-to-face appointment guidance’
It isn’t contractual.

Nick Mann 20 May, 2021 5:43 pm

“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.”…
…Just couldn’t help themselves, could they.

We do what NHSE tell us to do until they tell us off for doing it.

NHSE still failed to grasp the salient point: Covid or no Covid, there are evidently nowhere near enough slots (GPs) for us to give an appointment to everyone that wants one. We use Clinical acumen to ration. NHSE removes that agency from us, whilst patients’ expectations are made illusory. NHSE’s diktat is disingenuous and divisive, and they know it!

Douglas Callow 20 May, 2021 5:48 pm

Cancelled General Practice webinar the day the SOP is released
NK NW bulleting conflates populism (patients association like the SOP) with contractual freedom ARRS liberating primary care to deliver better and more

Concerned GP 20 May, 2021 5:52 pm

Can NHSE just stop sending out these messages and realise they have lost the confidence of many GPs and need to “reflect” on this? Or are they waiting for the next GP bashing headline to send us another missive? Yawn.

Patrufini Duffy 20 May, 2021 5:57 pm

An NHS England spokesperson? Ridiculous. Like me sending my neighbour out to comment. Kanani and Waller, like little kids, just come out, hide and seek is over, and say what you want to say to on camera.

Samir Shah 20 May, 2021 8:53 pm

1. 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.
2.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.
3. 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.’
4. eConsults should be offered 24/7.

Can you feel that warm fuzzy feeling of NHSE support?

John Graham Munro 20 May, 2021 9:15 pm

God—To think all those years ago ”I was so proud to have got into Medical School”

terry sullivan 20 May, 2021 11:36 pm

gps are not employees

tell nhse tfo

and tell bma the same

and grow a pair

gps seem to have stockholm syndrome–you are important in nhs–use your power wisely

mps are mostly low iq nonentirties–hence they are in politics

John Graham Munro 20 May, 2021 11:57 pm

TERRY SULLIVAN——–WELL SAID——WHEN I EXPRESS THE SAME I GET A LOT OF FLAK THE FROM OTHERS WHO WOULD RATHER JUST SIT BACK

Vinci Ho 21 May, 2021 6:39 am

Mmmmm
Let’s wait and see how reality bites in . One day of politics is too long .
At least , it is fair testing the water with the infamous letter failed NHSE/I.
But putting oneself in NHSE/I shoes , shouldn’t repeatedly failing this ‘task’ of testing the water (this is the second time; if labelling practice ‘closed’ last year was the first 👿) warrant a ‘sack’ by now ?
I feel for you , Nicki 😈🤨
Of course , it doesn’t help when I am such a prick calling you to resign all these times on this platform 😳👿😎😈

Vinci Ho 21 May, 2021 6:44 am

Correction
…..it is fair to say that testing the water ……

John Glasspool 21 May, 2021 12:32 pm

I wonder why Pulse use that same stock photo of a woman who looks like a rabbit in headlights?