Same-day scrutiny obscures what is really ‘urgent’

Copperfield on how the 2026/27 contract’s requirement for GPs to deal with clinically urgent cases on the same day is a smokescreen for more insidious changes

So that’s ‘dealt with’ dealt with. All the ambiguities around the new contractual requirement to deal with clinically urgent cases on the day have been ironed out, so we can all take the collective action of untwisting our knickers.

For a start, ‘clinically urgent’ is defined by us (GPs/receptionists) rather than by them (patients). Which is good, because patients get pretty good at gaming the system, as any paramedic currently being called out weekly to administer a GLP-1 injection to obese patients with ‘I think I’m having a heart attack again’ will tell you.

Also, despite the contract letter implying these on-the-day patients need seeing F2F, they can, in fact, be signposted. To where and under what circumstances remains unclear, but that’s probably just as well.

So we can carry on as before. Except for the new request for us to code these urgent requests (which sounds trivial) so that relevant data can be collected, which doesn’t. In fact, that admin click is us loading the gun which the ICB’s dashboard hit squad will shoot us with.

But this won’t really be an issue, either. Because ‘clinically urgent’ is a label that can only be applied retrospectively. While a ‘chest pain’ seen on the day which turns out to be a three month history of costochondritis wasn’t actually urgent, you can still code it as such. And a ‘feeling tired’ seen routinely, who turned out to be a new T1DM in DKA, also merits the coding clicks – because he was actually dealt with on the day it became apparent he was unexpectedly urgent. It’s a win-win.

Or, of course, you could just cheat and selectively code those you do deal with urgently the same day and overlook the others. Except for the fact that GPs, unlike patients, have never been known to game systems, no matter how pointlessly game-like the systems become. Not even with QOF, for example.

So, there’s nothing to see here. And maybe that’s the point. There’s a danger that this smokescreen will obscure other, more threatening changes – like the embedding of A&G into the new contract, which feels like the embedding of an axe in my cranium.

In other words, we’ve dealt with the irrelevant. Now let’s deal with the bits that actually matter.

Dr Tony Copperfield is a GP in Essex