GP practices are ‘under no contractual obligation’ to offer e-consultations at all, despite NHS England’s guidance last week to keep forms switched on at all times, the BMA and LMCs have said.
NHS England’s updated operating procedure said ‘switching off online consultation systems out of hours is likely to be less convenient for patients and reduce patient satisfaction’, although practices are not expected to respond to request outside core hours.
Practices which do opt to switch forms off outside core hours should inform their CCG and consider whether additional support may be available, NHS England had further said.
However, the BMA’s GP Committee has explained that while it has agreed with NHS England – as part of the 2019 GP contract deal – that e-consultations will become a contractual requirement eventually, they are not yet contractual at all.
A recent GPC England bulletin said: ‘Before the pandemic, as part of the 2019 GP contract deal, GPC England agreed that it would eventually become contractual for practices to offer online consultations during core hours. This agreement has not yet been added to the contract regulations, so is not currently a contractual requirement.’
It added that while GPCE had ‘agreed that practices should offer online consultations as early as possible, provided that the necessary infrastructure is in place’, it is not a requirement until it is ‘entered into the contract regulations’.
‘It is therefore for practices to determine how best they use online consultation systems, including what hours they are available,’ it concluded.
It comes amid reports that GP practices wanting to turn off e-consultation forms at weekends and evenings are facing ‘resistance’ from their digital provider and CCGs.
Berkshire, Buckinghamshire and Oxfordshire are among LMCs which have written to GP practices to advise that they are ‘under no contractual obligation to provide online consulting platforms at all’.
The letter, seen by Pulse, said: ‘We would like to reassure practices that they are under no contractual obligation to provide access to these platforms outside the core hours of 8am to 6.30pm Mon-Fri.
‘Furthermore, until the GMS Regulations are amended accordingly, practices are under no contractual obligation to provide online consulting platforms at all if they do not wish to.’
While some practices may find e-consultations ‘useful’, those who find they are ‘not helpful in the delivery of their services’ or are ‘not yet ready for their implementation’ can ask for them to be deactivated ‘either outside of core hours or completely’, it added.
The LMCs also advised that practices can remove the link on their website ‘as a temporary measure’ if deactivating the platform is ‘proving technically difficult’.
Other LMCs have also issued advice around e-consultations, with Londonwide LMCs recently reassuring practices that ‘currently there is no requirement for practices to provide online consultations’.
LMC advice said: ‘Practices may switch off their online consultation platforms outside of core hours, which will normally be done by contacting the platform provider, or in some cases just temporarily removing the link/embedded access to the platform from their website.
‘However, they should make it clear on the page that formerly provided access to the platform that patients should visit NHS 111 instead.’
Meanwhile, NHS England’s medical director for primary care has tweeted that the standard operating procedure – which also reinforced the order that patients must now be offered face-to-face appointments if that is their preference – is ‘guidance’.
Dr Nikki Kanani said: ‘We are looking forward to moving away from their use, and going back to supporting practices to work in the way that makes sense for their patients and teams.’
Despite this, Pulse could reveal last week that NHS England is monitoring how many face-to-face appointments GP practices are offering and asking them to justify ‘low’ levels.
It comes as the GPC has paused all meetings with NHS England until the disagreement around face-to-face appointments in practices is resolved, saying it has ‘no confidence’ in NHS England’s executive directors.
Today, health secretary Matt Hancock met with GPC to discuss the fallout. According to Mr Hancock, they discussed ‘what more we can do to strengthen access to GPs’, while the BMA said Mr Hancock ‘recognised’ the ‘extreme pressures currently facing general practice’.
It follows calls among grassroots GPs for the resignation of NHS England’s medical director for primary care amid the furore created by its letter – with a petition to that effect racking up over a thousand signatures.