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GPs threatened with breach of contract over ‘diverting’ calls to NHS 111



A row has broken out between LMC leaders and NHS England after officials threatened all London GP practices with contract breach notices if they continue to divert phone calls to NHS 111 during the day.

The letter, sent to all London GPs last week, quoted clauses from the GP contract and warned that NHS England would issue contract breach notices to practices if patient calls continued to be diverted to NHS 111 during core hours.

But Londonwide LMCs said they had not seen any evidence to back up the claim that practices were diverting patients to NHS 111 and have written to NHS England’s London area team asking them to withdraw the threats.

The letter from NHS England said that GP practices were contractually obliged to have ‘suitable arrangements’ for patients to access care in-hours, but that there were ‘increasing numbers’ of GP practices diverting patients to NHS 111.

The letter says: ‘It has recently come to our attention that there are an increasing number of examples where GP practices are diverting patients to 111 during their core hours.’

‘[R]egardless of whether your contract is GMS, PMS or APMS, does not constitute the Contractor having “in place arrangements for its patients to access such services throughout the core hours in case of emergency”.’

‘NHS 111 has not been commissioned as a service to either “cover” or “substitute” for general practice during its core hours of responsibility or to handle routine in-hours calls from patients who are attempting to contact their GP practice.’

‘Please be aware that a breach notice will be issued to any practice which is not making suitable arrangements for its patients to access essential and additional services during its core hours.’ Click here to read the full letter.

But Londonwide LMCs medical director and Hillingdon GP Dr Tony Grewal cast doubt on the ‘fairly unpleasant’ letter, saying there was no way of telling how a patient got through to NHS 111.

He said: ‘In writing back, what I said was that the letter was at best unfortunate in tone. That there was no evidence of practices not fulfilling their contract and more importantly, because of the way the 111 system and phone answering work, there is no way of telling whether a practice is using 111 to deliver in-hours services or whether a patient has got through to 111 by one of the other routes. I have had no response.’

‘We had actually already warned practices not to divert calls to 111 some weeks before but practices discovered that in some cases their cover organisation was flipping calls though to 111 because they had not made different arrangements for in-hours cover and for 111. It is part of the fact that no one has thought through the changes involved in the shift to 111.’

GPC deputy chair Dr Richard Vautrey said the letter was ‘very heavy handed’ and that it was unfair to blame practices for the problems with the service.

He said: ‘It is just a consequence of trying to roll out NHS 111 in a too hasty way and not thinking through the potential knock-on consequences and providing a solution before implementing it.

‘[NHS England’s letter] is not inaccurate, GPs have a contractual duty to arrange in-hours cover, but I think it is unfortunate in its tone, threatening breaches in that first letter.

‘It would be far more appropriate for them to highlight concerns and then offer solutions rather than writing out something in an officious and threatening manner. I think it doesn’t bode well for the relationship that the new NHS London teams will have with practices, and we really need to see a move away from that type of tone. Practices need to be worked with, not threatened.’

An NHS England spokesperson said: ‘The NHS 111 contract is clear that it should not be used by GPs during normal working hours when arrangements for patients should be in place.

‘To help manage any issues, Primary Care Commissioning heads in London wrote to GP leads and Practice Managers to clarify their contractual obligations for core hour support to patients. NHS England is working with local CCGs to consider all aspects of the NHS 111 service and to ensure the service is designed and commissioned in the best possible way to meet the needs of patients and the public. The letter was shared with the Londonwide LMC in advance of distribution.’

The news comes as the Government wants to make GPs ‘more accountable’ for out-of-hours care, with contract changes to be discussed as part of the negotiations for 2014/15.