BMA will continue to advise A&E signposting when capacity reached, GP chair tells Streeting

The BMA will continue to advise GP practices to signpost patients to A&E when their capacity is reached, its GP chair has told the health secretary.

GP Committee England chair Dr Katie Bramall has written to Wes Streeting this afternoon, imploring him to agree to a meeting to discuss GPs’ ‘genuine’ safety concerns surrounding online access.

In the letter, which comes in response to Mr Streeting’s accusation that GPCE is fostering a culture of extremism among local GP leaders, Dr Bramall stressed that patient safety ‘has consistently been, and remains, the BMA’s, GPC England’s, and the GP profession’s highest priority’.

‘It is disappointing that when tensions are so very heightened, we may see regrettable comments from all sides,’ she added.

‘As a regulated doctor, public confidence in my ability to tell the truth is high, and I will continue to tell truth to power. In this spirit, I implore you listen to me and my committee, as the elected representatives of the GP profession across England, when we warn of genuine and real concern.’

Likening the opening up to unlimited online consultation demand to ‘the ill-fated scheme to open carriageway hard shoulders as an additional permanent lane on motorways’, she said the Government’s actions could similarly prove fatal.

‘The same principles apply when you open up online GP pathways to potentially unlimited consultations, promising patients’ better access, but providing no more GPs to increase appointment capacity; promising to “end the 8am scramble” but providing no additional appointments. GPs now must manage many more patient requests and queries each day – revealing the huge unmet need across our communities.

‘As GPs we are warning you as our Secretary of State, that we cannot safely accommodate this unmet need simply by keeping all our access routes open no matter how full each “motorway lane” rapidly becomes.’

Last week, primary care minister Stephen Kinnock said that ‘doomsday scenarios’ over online consultation changes predicted by GP ‘refuseniks’ have not yet come to pass.

However, Dr Bramall listed evidence against this, including:

• ‘online consult platforms that crashed due to being overwhelmed by demand’;

• ‘the ongoing online surge driven by 1 October publicity, visible to you from data available to NHS England’;

• ‘my own practice has operated total triage and enabled online access for years yet has experienced a 25- 30% increase in demand, which is causing staff to stay late into the evenings to try to keep patients safe’.

‘This unsustainable demand will soon be exacerbated by the inevitable increase in demand that occurs during the winter months, and this will compound the mismatch between capacity and patient need,’ she added.

Dr Bramall’s letter went on to accuse the Government of refusing to meet with ‘online consultation platform developers or with GPCE to discuss embedding necessary safeguards’ despite her repeated asks in recent months.

‘These are essential to protect patients and GPs alike by ensuring urgent and emergency requests erroneously submitted online, among the many hundreds of other non-urgent requests and queries, are not missed,’ she said.

She also claimed that ‘we are already starting to see the development of waiting lists within GP practices’ as ‘an inevitable consequence of there being no additional appointments to respond to this new surge’.

‘This change simply highlights the scale of unmet healthcare need and is a natural response when no additional GPs and no additional appointments are possible without additional resource.

‘Unmet patient need and GP under/unemployment are in your gift to solve, as I have outlined to you in my previous letters. GP waiting lists becoming normalised akin to hospital waiting lists is not the legacy you are seeking, but it may well be the one you are remembered for.’

Highlighting that general practice ‘is not commissioned to provide urgent and emergency care’, she also stressed that the BMA ‘will continue to remind and advise practices that when safe capacity is breached on any given day, patients should be appropriately signposted to NHS 111, urgent care centres, walk-in centres, and community pharmacies, in line with the principles within the BMA Safe Working Guidance documents’.

And, in response to the health secretary’s shock at one LMC’s advice to signpost patients to A&E, she said: ‘When clinically appropriate and absolutely necessary, we will continue to advise that emergency departments be attended, in line with Good Medical Practice.’

Urging the health secretary to meet with her to discuss the issue, Dr Bramall signed off the letter telling him the ‘loss of trust’ between the Government and GPs is ‘yours to remedy’.

NHS England has written to all GPs urging them to ignore ‘irresponsible’ advice on contractual online access requirements shared by one LMC last week. North East and North Cumbria LMC was threatened by its local ICB with ‘breach of GMC guidance’ messaging, over advice it sent to GP practices on the new requirements.

This had suggested GPs should signpost patients to A&E in the first instance, and avoid Pharmacy First.

Despite the messaging not coming from the BMA, Mr Streeting wrote to Dr Bramall to say he was ‘shocked and appalled by the advice’, and his letter had urged her to ‘take responsibility for fostering an environment in which members and LMCs feel emboldened to make rash and unacceptable statements and interventions’, with ‘complete disregard to the consequences for patients and the NHS as a whole’.

Dr Bramall’s letter did not directly respond to the accusation.