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The new contract is backbreaking, but in a good way

The new contract is backbreaking, but in a good way

The imposed new contract is painfully hilarious, but at least GPs now have a clear contractual pathway for overflow, says Dr Copperfield

I’ve been laughing so hard, I’ve genuinely put my back out. It’s this imposed new contract.

So in thrall is NHSE (and by extension, the Government) to certain ‘voice of the people’ tabloids that in trying desperately to generate a contractual solution to those ‘Can’t see a GP’ headlines, they’ve succeeded only in making matters worse.

Painfully hilarious. I’m referring, of course, to the new requirement to give patients a definitive response to a contact, rather than suggest they try their luck another time. The idea is that this will prevent the ‘eight o’clock rush for appointments’ (NHSE version) / ‘patients being fobbed off by receptionists’ (tabloid remix). Because, by confirming that ‘phone back later’ isn’t an acceptable response, and mandating what is, NHSE has solved a longstanding problem in our favour. Specifically, what to do when we’re full.

Thanks to the new contract, we can now ‘Invite the patient to make use of, or direct the patient towards, appropriate services that are available to the patient’. Which will, of course, include 111 and A&E.

The very helpful explanatory blurb provided by Berkshire, Buckinghamshire and Oxfordshire LMCs confirms this. The only part of their otherwise excellent analysis I’d take issue with is that the previous contractual basis for diverting patients to 111 was ‘unclear’. No, it wasn’t. Some years back, when our practice was severely under the cosh, we asked NHSE whether we could send overflow to 111 and were told helpfully and flatly that we most certainly could not, because this would breach our contract.

Well, now we can, once safe capacity has been reached. And the BMA has helpfully defined that as no more than 25 clinical contacts per day per GP. At last: a lid on workload and a clear contractual pathway for overflow. Party time.

Though not for patients. I do feel a bit sorry for them undergoing a dizzying carousel of advice diverting them first from GP to 111, then back to the GP and finally, presumably, to A&E. But hey, vertigo should go to ENT anyway, so they end up in the right place.

As for me, the only downside is my back spasm. At least I know not to bother my GP, they’re contractually full. Can anyone remember the number for 111?

Dr Copperfield is a GP in Essex. Read more of his blogs here

Editor’s note: The blog originally quoted the BMA’s new contractual guidance, which said the safe level of patient contacts per day was no more than 35 contacts per day per GP. However, in separate guidance, the BMA has said no more than 25 contacts a day



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

Anthony Gould 24 April, 2023 9:13 pm

GP practices need more resources to assess and give appropriate disposition
I’m sure everyone wants to assess and manage patients appropriately but currently General Practice is under resourced for this
It can be done with the appropriate resources

Eric Wilkinson 24 April, 2023 10:13 pm

Erm…BMA says 25, not 35 contacts per GP per day is safe. Even Sajid Javid only tried to push it up to 28 a day- like he would know.

Clive Morrison 25 April, 2023 11:35 am

When I ask other professionals such as accountants, solicitors etc, to estimate how patients a GP sees in a day, they invariably say about 8.

When I explain the reality, they then say, “is that safe?”.

Truth Finder 26 April, 2023 2:44 pm

25 contacts a day. What about the queries, the medication problems or those Med 3s that need discussion? All not counted in our “normal” appointments. If anyone has done private work they will know how much extra we give.

David Jarvis 26 April, 2023 6:40 pm

Fun isn’t it. If you add all those “little” queries (same medicolegal risk but hey ho) it is a lot more than 35 and then a genius in the lib dems accuses us of rushing. Well I have news we are rushing. quart, pint pot anyone.

Dr No 26 April, 2023 10:23 pm

My best daily total actual patient encounters was 115. About 90 of those telephone triage (appts by another name) and the rest urgent extras clinic at 6pm. The next day I told my partners I was leaving unless we stopped triage – which we did, the Kings Fund published a great review which clearly showed lowering the access threshold increased demand, i believe triage is a response to an excess of demand over provision and should not be a routine part of general practice. It’s a lose/lose process. This 23/24 contract seems to imply triage. That’s a red line for me.