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Practices to provide phone access even when closed for training under NHS England revamp

Exclusive GPs will not be allowed to completely close and divert calls to an out-of-hours organisation within core hours under new rules being developed by NHS England for in-hours closing, Pulse can reveal.

NHS England said it is working on a national policy that will ‘allow area teams to apply consistent criteria’ when concluding what level of access is a contractual requirement, and a senior NHS official said the policy is likely to demand GPs provide services like appointment booking, hospital support and repeat presciptions at all times during core hours.

As it stands, practices holding GMS contracts can close during core hours as long as they have measures in place that meet the ‘reasonable needs of patients’, which GP leaders have said allows them to close for training purposes.

But speaking exclusively to Pulse, deputy medical director Dr Mike Bewick said NHS England is trying to stop ‘anomalies’ hindering patient access to routine primary care and that practices should retain at least a phone service during core hours.

Under the plans, area teams will be advised to look at feedback the GP Patient Survey to determine whether a practice was providing sufficient access to patients.

Dr Bewick said: ‘What we are trying to do is stop anomalies whereby some towns have no routine services on an afternoon, because everybody coordinates their [in-hours closing] to the same day. Practices have to close sometimes, for training and all that, and we are very happy with that.’

But he added that NHS England is ‘not happy with the total absence of a facility, or handing over to urgent care when some people might need normal, routine care’ – which he described as ‘an anomaly in the 21st century’.

Dr Bewick said that practices may have to work with other practices to set this up. He said: ‘What we have got is that some people can’t make a routine appointment in certain parts of the country on certain afternoons, and that just doesn’t seem to fit, to me, a modern general practice. However to do that you may need to have federated relationships with your neighbouring practices.’

He added: ‘It just seems to me very strange that despite everywhere else in the system is open for the whole of those core hours, and yet we have practices [that are closed]. It doesn’t mean everybody has to work longer hours to do it, it means you have to work cooperatively across practices so you can do it, because small practices have more difficulty than other ones.’

However, GPC chair Dr Chaand Nagpaul said that it is not always possible for practices to federate in this way.

He said: ‘The contract is very clear in that it says practices must provide essential services, and practices are fulfilling their contractual obligations.’

‘I think federation is not an immediate reality for most practices. Working collaboratively is an ambition but there are issues with federations that need to be worked out before that can become a widespread reality. There is no point redirecting patients to another GP practice if it does not have access to their records, does not share systems et cetera. This is dependent on having the right IT in place, the development of which also needs to be resourced.’

‘The other thing I would say is that at the current time, when GPs are struggling to provide their core services without sufficient funding, is not the time to ask GPs to do more above and beyond contractual requirements. I don’t think that you can expect practices to completely change their level of access with funding which has been set out based on a different level of access.’

The GPC has said it supports the setting up of a national policy on in-hours closing, although it was holding out hope it could sign if off before it is implemented.

Dr Robert Morley, chair of the GPC contracts and regulations subcommittee, who met with NHS England to discuss the issue in February this year, said: ‘There is agreement that the regulations places no obligation on practices to remain open throughout core hours. What they must do is meet the reasonable needs of their patients and clearly it would be helpful to have a consistent approach to how area teams tackle this.’

‘It would seem reasonable to use Patient Survey measures as one criteria for determining whether practices are meeting the reasonable needs for patients, but it must be in the context of practice circumstances. What is clear is that there is no contractual obligation to remain open. Practices must have systems in place to deal with any emergencies and they must meet the reasonable needs of patients throughout core hours. That is not the same as saying they have to be open throughout all of core hours, every day.’

Asked what level of input GPC has had in developing the policy since the initial meeting, Dr Morley added: ‘Well we are certainly expecting it to be discussed with the GPC.’

He added: ‘I don’t have any problem with trying to get clarity over this nationally in a consistent approach, I think that would be in everyone’s interest.’

An NHS England spokesperson said: ‘We are developing a policy in relation to opening hours so that area teams can apply consistent criteria to assessing what is required of a practice. We have had a meeting with some LMCs, CCGs and ATs to understand the issues and we have agreed that we would be forming a judgement about appropriate access, including using feedback from the GP patients survey. We will work with area teams to progress this.’

It comes as the RCGP defended GPs in light of a Daily Mail front-page article last week, which claimed that they regularly close in hours to do paid private work or take ‘four-hour lunch breaks’, while several GP practices were slapped with breach of contract notices after defying NHS England advice and closing early on Christmas Eve.