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NHSE: GP must be physically present at all times during PCN enhanced access hours


physically present


Exclusive A GP must be physically present at all times during PCN weekday evening and Saturday enhanced access appointments, NHS England has confirmed.

Earlier this month, the BMA GP Committee advised that a GP must be ‘available’, but not necessarily ‘physically’ present during enhanced access shifts offered by PCNs under the new DES.

This was based on ambiguity in the wording of the contract document.

However, NHS England has now said that a GP is required to be physically present at all times.

An NHS England spokesperson told Pulse: ‘From October, all primary care networks will be required to ensure a GP is available to see patients face-to-face on Saturdays between 9am and 5pm, as is already the case in many parts of the country.’

They confirmed on background that this means a GP must be physically present at one GP practice within a PCN area throughout the whole enhanced access service period – 9am-5pm on Saturdays and 6.30pm-8pm on weekdays.

The network DES said that enhanced access services should be ‘delivered by a multi-disciplinary team of healthcare professionals employed or engaged by the PCN’s core network practices, including GPs, nurses and additional roles [staff] and other persons employed or engaged by the PCN to assist the healthcare professional in the provision of health services’.

However, it added: ‘A PCN must ensure GP cover during the Network Standard Hours providing in-person face-to-face consultations, remote consultations, leadership, clinical oversight and supervision of the MDT.’

It comes as Pulse revealed last week that PCNs will need to provide GP appointments covering the ‘full’ periods of 9-5 on Saturdays and 6.30pm-8pm on weekdays.

It was previously unclear whether PCNs were required to provide appointments throughout the whole period rather than just within the stated hours.

The BMA last week said that NHS England has rejected its requests for certain relaxations of the DES, including around Saturday opening times and GP availability for the new extended hours service.

It has repeatedly encouraged practices to consider their ongoing participation in PCNs.

Practices have until 30 April to opt out of the DES without breaching their contract as part of the current annual opt-out window, but may have additional 30-day windows to do so if any in-year changes are made to the enhanced service specification.

Meanwhile, GPs attending the annual conference of UK local medical committees (LMCs) next month will vote on policy to reduce core GP hours to 9am until 5pm.

What is the PCN enhanced access service?

The DES set out the requirements for PCNs to provide enhanced service access from 6:30pm to 8pm on weekdays and 9am to 5pm on Saturdays.

Under the requirements, networks will have to provide 60 minutes’ worth of appointments per 1,000 population within the network, and these will have to be delivered within the hours stipulated.

The appointments will be available ‘for any general practice services and services pursuant to the Network Contract DES that are provided to patients, the DES says. It also says that they should be bookable a minimum of two weeks in advance, and that same day appointments should be made available.

The service will go live in October, when it will be funded £7.46 per patient pro rata. Until then, networks will receive 72p per patient for the preparatory arrangements.

PCNs must submit plans to commissioners by 31 July, which will set out the mix of services to be provided, how networks will offer appropriate levels of face-to-face appointments and what locations are to be used.

READERS' COMMENTS [10]

Dr N 29 April, 2022 11:46 am

30 million general practice contacts a month and 800 GPs les than last year and NHSE think this is reasonable. Lunatics are running the asylum.

Michael Crow 29 April, 2022 12:33 pm

One day left to opt out of the DES. I wonder if there will be a flurry of letters

Patrufini Duffy 29 April, 2022 12:56 pm

We all told you – they are coming for you. OPT OUT – or clear your personal life and diary. And don’t complain.

David Jarvis 29 April, 2022 1:37 pm

I am working on asking for forgiveness not permission. Smile sweetly and let them sack you. I am not resigning over this. I feel like currently we are playing a game of chicken but they don’t realise their in a smart car and GPs are in a tank due to our scarcity. As I watch them prattle on with their ideas I just watch and carry on as I am happy to do whilst ignoring all their stupid frippery. They need us more than we need them. What happens if they try to enforce Saturdays is I won’t do Saturdays and I will also stop doing Out of Hours. Very easy on a zero hours contract. Very powerful option right now until they attempt to return 24/7 365 responsibility. But these Saturdays are the bacon slicer approach to pulling back from our OOH opt out of 2004 for which we are all still paying.

Grant Jonathan Ingrams 29 April, 2022 2:01 pm

The NHS E can try bullying all they like (which is what is is). they have drawn up and enforced the specification, and this is not included in it. See Section 8.1 of https://www.england.nhs.uk/wp-content/uploads/2022/03/B1357-Network-Contract-Directed-Enhanced-Service-contract-specification-2022-23-primary-care-network-requireme.pdf They have enforced this year’s contract without the support of GPC, and if they are so incompetent that they did not make it say what they wanted it that is nothing to do with PCNs.

paul cundy 29 April, 2022 2:03 pm

Dear All,
AS USUAL PULSE IS STIRRING, THEY HAVE GOT IT WRONG.

A GP DOES NOT NEED TO BE PRESNT ON SITE AT ALL TIMES.

The PCN DES has no such clause. The DES is an extension of your core contract which requires a GP to be available, not present.
Do not be alarmed by these clickbait stories. Read the contract, see what it actually says and not what a junior reporter or middle level manager at NHSE thinks it says.
Regards
Paul Cundy

    Jaimie Kaffash 3 May, 2022 9:50 am

    Dear Dr Cundy,

    We did look at the contract in great detail – since the day it came out we have been querying this very point.

    The contract says: “8.1.31. A PCN must ensure GP cover during the Network Standard Hours providing in person face-to-face consultations, remote consultations, leadership, clinical oversight and supervision of the MDT.”

    We felt that this was open to interpretation, and that NHS England’s interpretation would be vital to understand when they would consider it a breach of contract. They have finally clarified.

    You might feel that it is wise to give GPs advice like this. And maybe the courts would agree. But our ‘junior reporters’ as you put it clarified that NHSE would consider this as a breach of the contract.

    Jaimie, Pulse Editor

Dave Haddock 29 April, 2022 4:03 pm

Thanks Paul!

Patrufini Duffy 29 April, 2022 8:37 pm

You’re all getting paid for it. Deliver what they ask. Honestly and usefully. Tax payers money. On a voluntary scheme.

Reply moderated
Christopher Ives 30 April, 2022 8:00 am

I think Paul Cundy’s interpretation is right. I think breach of contract would be hard to argue if the requirement for GP on site was not specifically stated. The NHSE statement quoted in pulse also seems to be still open to interpretation.

This national stand off is between GPs and NHSE is really not helping with finding a sensible way forward but I do see the need to draw to lines in the sand