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Exclusive: NHS England to include GPs in OPEL framework over the next year

Exclusive: NHS England to include GPs in OPEL framework over the next year

Exclusive NHS England will work towards incorporating general practice in the ‘OPEL’ system pressures framework over the next year, Pulse can reveal.

Winter plan documents published yesterday instructs ICBs to ensure tools are in place to’ understand demand, activity and capacity in primary care’, including operational pressures escalation levels (OPEL) reporting.

NHS England has told Pulse that it will work to incorporate primary care in the Opel Framework over the next year, but that in the short term it expect systems to have tools in place to understand primary care pressures.

‘This should be shared across the system to give a comprehensive view of primary care pressures and where support may be required that could alleviate pressure on primary care and on the [urgent and emergency care] pathway,’ a letter to ICSs from NHS England chair Amanda Doyle said.

GP Alert System

The news comes as LMCs have been leading the development of the General Practice Alert State (GPAS) with the aim of escalating ‘black status’ reports to NHS leaders.

This would be equivalent to OPEL level 4 in hospitals – a situation when pressure means organisations are unable to deliver comprehensive care and patient safety may be compromised.

Currently, 40 LMCs led by Devon LMC are collecting GPAS data from their practices and 20 more are rolling out the system, with the first national report published at the beginning of July.

Pulse understands that 60% are reporting red or black alerts indicating unsustainable pressure and 80% are reporting levels of patient contacts roughly double or more the level general practice is funded to deliver.

Meanwhile, winter plan measures, set out at the NHS England board meeting in Birmingham yesterday, will ‘boost capacity and resilience’, according to the commissioner – although they include no additional funding for general practice.

It said that to assist system working this winter, next week they will also be publishing an updated OPEL Framework to ensure ‘we are taking a consistent and co-ordinated approach to managing pressures across all systems’, but Pulse understands this will not include primary care yet.

The winter plans also included a nationwide rollout of ‘care traffic control centres’ to provide ‘one stop’ for staff to locate and co-ordinate discharge options for patients, expanding the use of Acute Respiratory Hubs, extra hospital beds and strengthen ambulance response to mental health calls.

It also included a new scheme to encourage trusts to ‘overachieve’ on performance measures with financial incentives provided for these areas.

The funding announced as part of the plan included:

  • £1b of dedicated funding to support capacity in urgent and emergency services, building on the £500m used last winter.
  • £250m worth of capital investment to deliver additional capacity.
  • £200m for ambulance services to increase the number of ambulance hours on the road.
  • Together with DHSC, an additional £1.6bn of discharge funding over 2023/24 and 2024/25, building on the £500m Adult Social Care Discharge Fund.

However, GPs have raised concerns about the lack of extra funding to support general practice within these plans.

Dr Steve Taylor, GP spokesperson for the Doctors’ Association, told Pulse that the lack of funding for general practice in the plan was ‘concerning’.  

He said: ‘It is known that many attend for “emergency” treatment at A&Es because of lack access to non-urgent GP appointments.

‘With GPs already providing two million extra appointments a month, on top of the 1.3 million a day, it doesn’t take many unable to get an appointment to overwhelm A&E departments.

‘The Government need to recognise that GPs need more support not less, particularly as over 10% of the population are now waiting for hospital  treatments, some of which is urgent.

‘Winter pressures will have a greater effect on primary care and funding here will be more cost effective, helping to prevent urgent care being overwhelmed.’

RCGP chair Professor Kamila Hawthorne told Pulse: ‘Last winter was one of the most difficult the NHS has ever experienced, and our own college surveys warned that without urgent action, this coming winter would be even worse.

‘GPs and our teams deliver a vast amount of patient contacts for the NHS and play an absolutely crucial role over the winter period.

‘If the government wants to ensure that patients can access GP services this winter, it will need to create a plan that ensures primary care can cope with the seasonal surge in demand.’

Last year, also NHS England provided ‘no additional’ winter funding to support GPs.

And yesterday, GPs warned of ‘intense workload and workforce pressures’ as practices have offered millions of appointments more per month than in 2019, despite the number of GPs continuing to fall.



Please note, only GPs are permitted to add comments to articles

Turn out The Lights 28 July, 2023 12:20 pm

We are saved,not, included in the opal system and care traffic control centres.All we nee now is for Captain Scarlet to take out the Mysterons in NHSE.

christine harvey 28 July, 2023 1:07 pm

I’m sure taking administrative time to return ever increasing data about how busy we all are will improve the situation immeasurably

The Prime Minister 28 July, 2023 1:19 pm


SUBHASH BHATT 28 July, 2023 1:47 pm

What can this funding used for? This is important issue. ANP ? Nurse practitioner? . They need to fund gp post .
iCB should have pool of gps available to help. I know easy said than done. Otherwise OPEL will turn out to be a Charcoal lump.

David Church 28 July, 2023 1:48 pm

I wish someone would take out the Mysterons in NHSE ! (and those in Government too).
General Practice appears not to need extra funding, because as GP numbers have dropped, this has somehow freed up more time for millions of extra appointments, so clearly the answer is to reduce the number of GPs even further, thus providing such an increase in appointment availability, that, soon, there will be a surplus!
Meanwhile, all this talk of extra beds is pointless. A whole ward at our local hospital is closed, and another nearby is struggling to stay open, because there are not enough nurses to staff them, and not enough applicants for the vacancies advertised.
Are we going to see Government soon having to conscript young people to work as Nurses in National Service?
Actually, that might be better for many than unemployment, so long as the minimum wage is high enough. But who will train them?

The Locum 28 July, 2023 2:33 pm

Who even cares about this nonsense anymore? Not funded, no intent to fund – we’re drowning already – nil return from General Practice as additional work when Rome’s already burning. Keep playing that fiddle.

John Charlton 28 July, 2023 4:47 pm

Deckchairs and the titanic. What is really worrying is just how far from reality – the coal face these managers are.

Michael Mullineux 28 July, 2023 4:53 pm

Reporting an utterly meaningless waste of admin time. Everybody including local ambulance trust, local trust and most practices on amber or red alert, but there is no help or hope of ‘rescue’ on the horizon

Fedup GP 28 July, 2023 5:34 pm

I heard they had a meeting – and it was being rebranded from OPEL to Strategic Team Analysis Reporting Busy Unmanageable Repeatedly Stressful Times.

Azeem Majeed 28 July, 2023 5:54 pm

The GPAS system is a positive step, but it is important to ensure that it is used effectively. The lack of additional funding for general practice is a major concern. GPs are already under significant pressure, and this is only likely to worsen this winter.
The winter plans include some positive measures, such as the rollout of care traffic control centres. However, it is important to ensure that these measures are adequately funded and resourced.

David jenkins 28 July, 2023 6:06 pm

David Church

i have just come out of west wales general hospital, where i spent three weeks on oxygen etc. i spent the first four days in a chair/trolley, as i was told “no bed to put me in”. when i was admitted to a four bedder on the ward, the two bed bay opposite me was full of storage stuff, with no beds there.

i have to say all the staff were absolutely superb. it’s the managers causing the problems – we all know that. but the managers aren’t going to cut back on themselves, are they ?!!

Darren Tymens 31 July, 2023 9:35 am

It is a bit of a twin-edged sword.

I understand that the intent is to give us parity with secondary care, and to alert commissioners to the fact that we are struggling to cope with demand. But frankly we are all struggling and the reasons are obvious: too little funding and too much micromanagement.

If we do report amber or red status, what will the commissioners do? I suspect they will shrug their shoulders and ignore it. They don’t have anything to offer, and even if they did they wouldn’t want to offer help anyway as they are obsessed with secondary care. They might, however, also use the OPEL evidence to repeat their (incorrect and mendacious) mantra that general practice is obviously failing and needs to be replaced by another system.

Guy Wilkinson 4 August, 2023 9:28 am

Agree Darren – it is currently pointless beaurocracy, but will be used as a data stick to beat us with in future

David Jarvis 4 August, 2023 9:45 am

Black report cut and paste daily. Next