NHS 111 has been asking GP practices in Wessex to take on extra patients beyond agreed slots, according to local medical committees.
Wessex LMCs, which represent practices in Dorset; Hampshire and the Isle of Wight; Bath and North East Somerset; Swindon and Wiltshire, said it has heard of NHS 111 phoning practices to ask them to take additional patients or a telephone referral.
Practices are required to make one appointment per 3,000 registered patients per day available for direct booking by NHS 111, but the LMC pointed out that taking on additional patients or phone referrals is not covered in the GP contract, and that GPs should ‘direct them to either book into one of the slots or identify another disposition.’
In an update to practices, the LMC said: ‘We have increasingly received questions about the responsibilities practices hold when interacting with NHS 111 and felt it would be helpful to highlight some aspects of this.
‘The number of appointments to be made available for direct booking by NHS 111 are at a rate of 1 per 3000 patients per day.
‘You do not have to accept more than this or via another communication method.’
The LMC also said that practices can re-triage the patients and contact the patients in a manner that they determine as the contractor, adding: ‘You are not contractually bound by the suggestions that are made by the NHS111 algorithm about timeframes and method of contact.
‘General practice is not an emergency service and urgent or one-hour dispositions are not appropriate to be directed to general practice.’
The guidance said that if practices are ‘under significant pressure’, they can ask ICBs to suspend the requirement to allow direct booking by 111.
It added: ‘We would recommend using the GPAS reporting system (and any additional localised systems) to highlight weekly the pressure your practice is under.
‘If under significant pressure your ICB should have a process to determine if you can suspend this requirement due to patient safety concerns.’
A GP in Dorset, who wanted to remain anonymous, told Pulse: ‘We have had problems with NHS 111 and have discussed them with the LMC.
‘We have had near misses where 111 booked slots where partners were not available.’
Dr Neil Bhatia, a GP in Hampshire, said: ‘We have appointments reserved for 111 every single day and every practice has to – I don’t see why they would need to do that ask practices to take additional patients when a practice is already full.
‘We would personally resist that – if it’s urgent, NHS 111 should deal with them. As a clinician, this sounds counter intuitive. If practices are full, it wouldn’t be safe.
‘I think this is a symptom of a system that is overwhelmed and there needs to be a national overflow system.
‘The difficulty is that practices reach capacity and once they do, the only overflow system is 111 – if we reach capacity we have historically diverted to 111 due to being overwhelmed.’
It is unclear from the LMC report which NHS 111 provider or providers it is referring to and the LMC did not return Pulse’s requests for comment.
NHS 111 provider Dorset Healthcare failed to comment when approached by Pulse.
However, a spokesperson for South Central Ambulance Service said: ‘Our 111 service does not have a standing operating procedure in place where staff will call practices requesting them to accept new/ additional patients, and currently demand and clinical queues are being managed effectively and within expected timeframes.
‘Clinicians and team leaders will occasionally call a practice where a patient is registered if the patient is clinically vulnerable, for example, where an elderly or confused patient needs a GP or practice interaction or where they have a clinical concern.
‘Clinician to GP practice, or clinician to clinician conversations are common practice where there is a concern and the patient needs an advocate.
‘If practices are able to provide specific examples either as complaints or via healthcare professional feedback forms we would be happy to investigate further.’
A spokesperson for NHS 111 provider Practice Plus Group said: ‘NHS111 is provided a limited number of slots to book a patient directly into GP practices, so where a patient need is deemed best served by the in-hours GP, NHS111 may make an enquiry to see if the GP can support that patient.
‘There is certainly no standard practice of requesting more slots than allocated, and we haven’t received any feedback from GPs to suggest this is happening.
‘If a small number of NHS111 clinicians have called a GP to ask if they have capacity, this doesn’t seem unreasonable and would be a reflection of them acting in the patient’s best interests. There is no obligation for the GP practice to accept them.’
Last month, NHS England said that GP practices should only direct patients to NHS 111 in ‘exceptional circumstances’, despite new contractual requirements, and must inform their ICB when doing so.