NHS England has threatened GP practices with breach notices unless they enter into contractual arrangements with out-of-hours cover providers during core hours over the Christmas and New Year period.
GPs will also have to ensure that any cover organisation has access to patient records and receives sign off from their CCG, under guidance issued by NHS England to practices.
However the GPC has published conflicting guidance for practices on the BMA website, arguing that NHS England’s stance is ‘not consistent with the contractual regulations’ and that it has rasied the ‘inaccuracy’.
The latest guidance comes a year after 12 GP practices in London were hit with breach notices after defying national guidance not to close early on Christmas Eve and New Year’s Eve following the area team callling all practices to check if they were open.
NHS England said at the time that every GP practice in England would have to remain open from 8am to 6:30pm on Christmas Eve and New Year’s Eve following a ‘non-negotiable’ final decision.
In a letter this month to GPs via area teams, NHS England wrote that ‘if the practice is “doors closed” during core hours, then patients need to have absolute clarity about how to access essential services’.
It said: ‘As a minimum, you will need to have a system in place so that patients can access GP services, including urgent care, either by ringing the surgery and [b]eing able to talk directly to a clinician to ascertain how they can access services if they need to; [or an] answer-phone message signposting the patient to an on-call GP for the practice.
‘If this is part of a service commissioned by the CCG (e.g. using the out-of-hours service in-hours,) then this must be with prior written agreement with both the provider and the CCG commissioner of that service.’
‘NHS England does not feel that practices can reasonably claim patients receive a service that meets their reasonable needs from a sub contracted provider, unless that alternative provider has access to the patient’s record if required to assist the consultation.’
NHS England added GPs should not use out-of-hours organisation without a contractual pre-agreement because of the existing pressure on the services.
But the BMA advice said: ‘You may be aware that NHS England recently issued guidance on this matter, distributed to area teams, in which it was claimed that practices could receive breach notices if they fail to open from 8am to 6.30pm on Christmas Eve and New Year’s Eve. This is not consistent with the contractual regulations and we have alerted NHS England of this inaccuracy.’
‘The contractual position is that GMS practices are entitled to subcontract services to an appropriate provider.’
In a note to LMCs, the GPC added that in its view, the area teams themselves are in breach of contract for issuing this guidance. It wrote: ‘The GPC has been made aware that practices in some areas of the country have been receiving communications from area teams withdrawing previously agreed acceptance of early closure on 24th and 31st December 2013.
‘The position of GPC has not changed and the guidance available on our website still applies.
‘It is our view that area teams should not change their position because of further guidance they have received from NHS England when there has been no evidential change to suggest there will be an increased demand for services during these times to warrant it. Our view is that area teams themselves may be in breach of contract in doing so.’
Practices have also been asked to fill out a form stating their opening period plans for the holidays.
Londonwide LMCs medical secretary Dr Tony Grewal said: ‘Unfortunately, even for practices who intend to work as normal, this request is covered by the requirement in the contract regulations [regarding] provision of information.’