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GPs should only direct patients to 111 in ‘exceptional circumstances’, says recovery plan

GPs should only direct patients to 111 in ‘exceptional circumstances’, says recovery plan

GP practices should only direct patients to NHS 111 in ‘exceptional circumstances’, despite new contractual requirements, and must inform their ICB when doing so, NHS England has said.

Under GP contract changes, coming into force from next week (15 May), practices are contractually obliged to offer an ‘appropriate response’ to patients the first time they get in contact and direct them to the right service.

GP leaders had warned the new requirement would ‘likely result in practices diverting extremely large numbers of patients to 111 and A&E for fear of being held in contract breach, due to the unclear meaning of this clause’.

But the recovery plan has now made clear that practices should inform their local ICB primary care team when they need to divert patients to 111, which ‘should only be in exceptional circumstances.’

The document said: ‘Practices should inform their local commissioner (ICB primary care team) when they need to divert patients to 111, which should only be in exceptional circumstances.’

According to NHS England, the recovery plan ‘focuses on access to make it easier for the public to contact practices when they are open and get a timely response’.

‘The 2023/24 contract requires practices to assess patient requests on the day – they should not normally be asking patients to call NHS 111 when the practice is open. As this plan delivers, we expect it to relieve pressures on 111 during the day,’ the document added.

The ambition of a move to a ‘Modern General Practice Access’, is to ‘tackle the 8am rush, provide rapid assessment and response, and avoid asking patients to ring back another day to book an appointment’, NHS England added.

As part of plan, the Government announced £240m funding for practices in England to ‘embrace latest technology’. However, practices will need to sign up to the scheme by 1 July to receive support by NHS England.

This had already been stipulated in the contract imposition, which said that practices will be required to procure this technology from a national framework, called Better Purchasing Framework.

The recovery plan said that the commissioner will support the transition to digital telephony for practices that commit by 1 July to the move, including procurement, contract negotiation and financial support for new equipment, transition costs and training.

A analogue telephony that implements Modern General Practice Access, can expect an average of £60,000 to support the move to digital telephony, digital tools, and transition support over the next two years, NHS England said.

The document said: ‘Our ambition is to transition at least 1,000 practices before the end of 2023, so around 65% of all practices will be using this technology, and we expect to transition all other practices who sign up by the end of March 2024.’

The Government also said that as part of the plan it will enable patients to obtain prescription medicine for earache and sore throat from the pharmacist without a GP prescription.



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

Simon Gilbert 9 May, 2023 12:43 pm

Every day is ‘exceptional’ in #NHS!

Simon Gilbert 9 May, 2023 12:46 pm

For my second comment I’ll point out that, as per usual, NHS Central Planners have misunderstood the difference between peaks and troughs of demand vs capacity.
Most practices only have unused ‘capacity’ during semi-finals or better of England football competitions, or on the afternoon of Christmas Eve, and in recent years even those slots are fully used.

Douglas Callow 9 May, 2023 1:12 pm

Tory’s are simply calling the BMA/GPCs bluff -put simply by making use of ARRS clinical signposting/triage pharmacy first he really should not need NHS 111 during the day and you have got plenty of time to care and in any case there will be no more money as tax cuts with the only thing that we will now stop labour from having an outright majority

Douglas Callow 9 May, 2023 1:13 pm

Obviously very deluded but them’s the breaks

Finola ONeill 9 May, 2023 1:32 pm

Crikey. I am actually interested to see how this pans out. Surely got to be masses more directed to A&E or referred straight to primary care. Either that or zero GP follow up or chronic disease management. Hope someone will be auditing the effect on unnecessary ED dispositions, secondary care referrals.

David Banner 9 May, 2023 1:53 pm

No 111? Ok, everyone to A&E it is then.

Daryl Mullen 9 May, 2023 2:14 pm

Where in the GP contract does it say “they should not normally be asking patients to call NHS 111 when the practice is open“

Deborah Owers 9 May, 2023 2:15 pm

Which bit of there is no more capacity are they not understanding?

David Church 9 May, 2023 2:21 pm

Well, a global pandemic is exceptional circumstances, and being at war with Russia is exceptional circumstances, and a national shortage of qualified GPs is exceptional circumstances, and breaking off negotiations and imposing a pay cut is exceptional circumstances, and causing inflation to suddenly rocket is exceptional circumstances, so that’s OK then, we can refer to 111 until inflation comes down below 1%, Covid goes away, the war ends, and the new GPs arrive, probably all in at least several years’ time!

Fay Wilson 9 May, 2023 2:32 pm

This is the access plan guidance from NHSE, it is not the contract underpinned by regulations.

Practices seeking to satisfy NHSE on “exceptional circumstances” could refer to an exceptionalism threshold of 25 consultations per wte GP.

SUBHASH BHATT 9 May, 2023 2:42 pm

I think it is right not to direct any patient to 111 during working hours. Try and ring 111 and you would know how difficult it is. Gp need to accommodate all urgent calls themselves or to give appointment at appropriate time depending on symptoms.

David Evans 9 May, 2023 4:05 pm

i have just enjoyed reading Berks LMC guidance on this matter which i basically says “poke it” ..well that was my interpretation anyway

Ian Haczewski 9 May, 2023 5:44 pm

At the end of the day we have to protect ourselves and stick to the recommendation of 25-30 pts maximum per day . I’m afraid that should be ceiling .

paul cundy 9 May, 2023 6:47 pm

Dear All,
So when will we see NHS111 only refer on in “exceptional circumstances”?
My review of 1/12s worth of NHS111 outcomes was that 80% of contacts were referred to A/E or sent a an ambulance.
Paul C

Just My Opinion 9 May, 2023 7:23 pm

It’s ok, they’re all going to be sent to A&E, so no worries NHSE!

Bonglim Bong 9 May, 2023 10:37 pm

Is exceptional once GPs have hit the 25 decision limit?

So pretty much every day.

Rogue 1 10 May, 2023 10:27 am

Maybe that’s the idea? We all report exceptional circumstances every day
Just like the hospitals report they are over capacity

Darren Tymens 10 May, 2023 11:37 am

1. every day is exceptional due to under-funding, under-staffing, and lack of capacity.
2. they can ask nicely, but they can only make us do what the contract (the one they wrote and imposed on us) says. I can’t see why anyone would bother asking the ICB for permission to do what they are contractually obliged to do (ie refer demand in excess of capacity to 111 and A&E).

Nicholas Sharvill 10 May, 2023 1:10 pm

SUBHASH BHATT IS A BRAVE DR TO SUGGEST that practices see people who need to be seen so to add fuel to the fire and recognising PULSE has an editorial slant that is not in keeping with a GP being a very well paid vocational life I will add a comment
I am not too involved now but until relatively recently that would be the norm and the practice would be contractually and legally liable if they did not do this. Along came covid and the assumption that GP would not/could not see people with covid, though many practices did there are still practices with covid messages on their websites and answerphones suggesting ”someone else ” needs to see them. CCG/PCN/ICB seem to have no role now in giving patients a voice (ie demand that ear syringing is done as part of core services). There are practices that do still provide a services well beyond what one reads in the lay press, many though appear not to and there is no comeback or loss of income to those that dont. Off to work shortly

John Evans 11 May, 2023 2:37 am

Ear syringe? Electronic irrigation hopefully.

Jamal Hussain 13 May, 2023 11:39 am

After reading of that sentence General Practice is doomed , “ practices are contractually obliged to offer an ‘appropriate response’ to patients the first time they get in contact and direct them to the right service.”
They are essentially forcing practices to provide in house 111 style assessment via their reception staff when they answer the phone. They can’t even just be given an appointment later that day as it may not be the right service.
Retire, locum or move to Australia.

Anonymous 15 May, 2023 7:05 am

Meanwhile I am charging £950 per day.

Truth Finder 15 May, 2023 5:04 pm

It is exceptional now. Too much paper work and work coming in all directions tasks, letters, emails, telephone calls…….not to mention CQC, NHSE, ICB. Their message it let’s do everything else and seeing the patient is last.

Ian Pidgeon 12 June, 2023 2:20 pm

The surrey/Sussex LMC letter is fab too… It’s the first time we’re contractually obliged to refer to ED/111, as per the “referral to an appropriate service”.

Point being…my appointment slots are not infinite, thus when they are full up, I’m done.
By all means 111 and ED can also ‘fill up’ and close their doors if they want, but that isn’t under my control>

TBH…I’ve told my staff nothing will change…