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GP NI contract reforms could keep 100% triage and Covid centres

Exclusive The system of telephone triaging all patients, and the referral of patients to community assessment centres, may be included in the Northern Irish GP contract in the future, with the BMA and RCGP currently being consulted on plans.

The NI Government officially launched its strategy for rebuilding health services following the Covid-19 pandemic this week, including plans for telephone triage and video consultations to become ’embedded’ in general practice.

But some GPs critical of the plans accused the NI Government of ‘capitalising on the Covid-19 crisis’ to force GMS contract changes.

The NI Goverment strategy document said: ‘All patients are now subject to telephone triage for around five minutes. Whilst exact figures are not available, it is clear that this triage addresses issues for a significant number of patients, thereby reducing numbers needing a more detailed consultation.

‘This consequently reduced pressures on GP surgeries. The outcome has delivered a transformational impact and there are therefore clear benefits to continuing this operating model.’

Launching the strategy, health minister Robin Swann said despite the challenges posed by the pandemic, its innovative and committed response had led to opportunities to make improvements to the NI health system which ‘was in very serious difficulties long before coronavirus reached these shores’.

He said: ‘We must build on that spirit in the months and years ahead. Innovations like telephone triage and video consultations will be embedded in primary and secondary care.’

The NI Government said it will also said be building on the model of ‘Covid centres’ when reconfiguring Health and Social Care Northern Ireland (HSCNI) for the future.

Across Northern Ireland, 11 Covid Centres have been established, while GP practices dealt with 23,441 Covid-related queries between 9 April and 6 May.

Of the 3,702 patients who were triaged and referred to a Covid centre, 75% were provided with advice on self-management; 15% were referred to secondary care; and 10% were referred to other services. 

The strategy document said: ‘Given the clear benefits of the approach, consideration will need to be given to what can be learned from the model and what elements ought to be retained to support longer term transformation of the HSC.’

‘The primary care sector will now consider the continued and expanded use of telephone and video technology in delivery of GP services. The sector will also consider ways to integrate more effectively with other sectors,’ it concluded.

However, some GPs have criticised the Covid centres for being costly and under-utilised.

BMA Northern Ireland’s GP Committee and RCGP Northern Ireland are now being consulted on plans for changing services for the longer term, according to a NI Health and Social Care Board document leaked to Pulse.

The paper says it is a draft that will be amended following ‘discussion with regional Covid centre leads and the leaders of GPC and RCGP’.

It suggests that Northern Ireland could ‘re-focus the GP contract and enable enhanced federation services’, with pandemic changes becoming ‘part of the normal operation of services in NI’.

Crucially, it suggests this should include ‘rapid access assessment and treatment services’ covering ‘a range of clinical areas’, which should ‘operate 9am-6pm seven days a week’.

Other changes suggested include reviewing the ‘form, function and role of [out-of-hours] unscheduled care’; and ‘new models of GP support for patients in care homes including single practice models for homes with appropriate digital support’.

However, some GPs have expressed their concerns with the plans.

A rural GP who wished to remain anonymous told Pulse: ‘GPs in Northern Ireland, who have been very concerned by coerced working in Covid centres, are now very alarmed by the prospect of Covid centres continuing for the foreseeable future, merging into acute assessment centres, that our GMS contracts could be permanently changed.

‘Federations are meant to represent GPs and instead are Trojan horses for the Department of Health to enforce change. This paper is the result of discussions with the leaders of GPC and our union, which is meant to safeguard our employment rights, not be colluding in the derogation of those rights which this paper proposes.’

Another anonymous GP, from the South East of the country, said: ‘Several of my colleagues have told me of their increasingly firm plans to walk away from general practice if this is how we are going to be dealt with by the health authorities. If the seven-day service was pushed through, I imagine most partners would resign immediately to regain control of their work.

‘We fear this may represent the final nail in the coffin of general practice. We have reason to fear that the BMA and RCGPNI are planning complicity with this undemocratic unilateral destruction of GMS.’

BMA GP Committee chair Dr Alan Stout told Pulse: ‘There are no definite contractual proposals or discussions yet. We have an agreement that our contract freeze will last for the foreseeable future and likely the rest of this year.

‘There will clearly be an opportunity to review all of the contractual arrangements including QOF and enhanced services as the year progresses and relating to priorities.’

Meanwhile, RCGPNI told Pulse that the Covid centres had ‘worked extremely well with only a small percentage of patients seen at the Covid assessment centres moved on towards secondary care, therefore easing pressures on our health service at a time of crisis’.

But the spokesperson added: ‘As the numbers presenting in the centres decreases it isn’t sustainable or right to maintain high levels of staffing and associated resources, so we do anticipate some changes to their current arrangement. Any alterations to the GMS contract and negotiations around any possible GP contract changes rests with NIGPC/BMA NI and not RCGPNI.’