ICB threatens local GP leaders with ‘GMC breach’ over online access advice

One LMC has been threatened with ‘breach of GMC guidance’ messaging, over advice to GP practices on the new online access requirements.

North East and North Cumbria ICB said the advice shared by the local LMC ‘contravenes Good Medical Practice as detailed by the GMC’.

This referred to a list of ‘pre-set messages’ for practices to use after individually triaging patients depending on the circumstances, after the new online access came into force at the beginning of the month.

The advice, which the LMC told Pulse was ‘not approved in the format sent out’, said that if ‘there is not enough information’ for practice staff to ‘safely decide what the next steps should be’, patients will need to complete another form with more detail or call 111 out of hours, or ‘attend A&E’ if they feel the problem is ‘urgent and serious’.

It added: ‘If you’re diverting urgently, please use ED as this is the only part of the system that ICBs and NHS England do not want to see overwhelmed, and they will listen to foundation trusts if it happens.’

The ICB said the ‘implication’ that patients should deliberately use emergency departments for urgent care to ‘overwhelm departments to make a point’ was ‘professionally inappropriate’ and ‘frankly dangerous to patients’.

In a response to the LMC, seen by Pulse, the ICB’s chief executive Samantha Allen said: ‘You will be more than aware of the correlation between increased mortality and excess deaths associated with Emergency Department overcrowding.

‘I am appalled that a medical professional in a senior leadership position can advise a strategy which is proven to harm patients. I would argue your communication contravenes Good Medical Practice as detailed by the GMC.

‘As we look to implement the NHS 10 year plan, we must transform care for our patients. I know that our colleagues, across primary care, are working hard to do this.

‘I am therefore shocked that you are prepared to undermine your profession and, in doing so, provide a disservice to your colleagues who are working tirelessly to support patients across our region.’

Pulse understands that the ICB escalated the situation to NHS England.

The advice also said: ‘You will note there is no option to divert to pharmacy – this is because Pharmacy First is a scheme that by design has significant potential to undermine us and, frankly, ICB and NHS England want us to get patients used to being seen by less-skilled people, to further enable the steady downgrading of patient expectations.’

However, the advice did mention telling patients to ‘visit your local pharmacy’ in the list of pre-set messaging.

North East and North Cumbria LMC chair Dr Paul Evans said the advice was sent out as ‘an administrative error by back-office staff’ and that neither him nor GPCE member Dr Becky Haines ‘approved’ the contents and are ‘looking into how it was sent without their knowledge or consent’.

The advice has since been taken down from the LMC website. The LMC said that it refuted the ICB’s ‘baseless allegations regarding professionalism and intent to cause patient harm’.

Pulse has contacted the ICB and NHS England for comment.

BMA council chair Dr Tom Dolphin and GPs committee England chair Dr Katie Bramall said that they understand that the advice was sent ‘in error without the knowledge of the authors’.

In a statement, they added: ‘NHS England has seized upon it, creating division and volatility between the two branches of the profession under arguably the most public-facing pressure and scrutiny: emergency medicine and general practice.

‘Whilst we expect all general practices to comply with the regulatory and contractual changes introduced by the Government on 1 October 2025, we remind GPs to review their online consult tool processes, ensuring where possible that measures are in place to prevent urgent requests from being submitted erroneously. The number one priority for the BMA and its members continues to be patient safety.

‘We recognise both general practice and emergency medicine are at breaking point. But we remind practices that they operate within a wider healthcare system which needs to do more to support urgent unmet patient need.

‘Our advice remains that if capacity is reached, practices should signpost patients to NHS 111, their local community pharmacy – also under huge pressure – urgent care centres and walk-in centres. Emergency Departments should only be attended when absolutely necessary.’

A spokesperson for the ICB said: ‘We have been clear that the contents of the letter, which has now been withdrawn, were inappropriate and do not reflect our views or that of the wider NHS.

‘Driven by the aspirations of the Government’s 10-year health plan, the NHS is undergoing a period of transformational change. Our colleagues in primary care are working extremely hard to deliver for their patients and as an ICB we are fully committed in supporting them and the wider healthcare system to that end.’

Since 1 October, GPs have been contractually required to keep online systems open for patient requests between 8am and 6.30pm for routine enquiries regardless of capacity, and ICBs have been told by NHS England that they should ensure the changes are implemented.

The BMA’s GP committee England formally entered a dispute with the Government over the issue on the same day, arguing it signed up to the policy only on the condition that ‘appropriate safeguards’ would be put in place, so that urgent requests cannot be sent online and potentially missed.

Pulse revealed last week that several GP practices have already been threatened by ICBs with contract breach notices.

Yesterday the primary care minister denied that the new requirements have been causing ‘doomsday scenarios’ predicted by GP leaders, and took aim at the ‘rump of refuseniks and their cheerleaders in the BMA who are intent on whipping up this issue’ around the changes.