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LMC Response to Standard Operating Procedure Update Letter

Publication date: May 2021

Many people working in general practice will be concerned by the updated Standard Operating Procedure to support restoration of GP services, published on 13th May 2021, which advised GP practices on how to improve patient access. Dr Richard Vautrey issued a response on behalf of the GPC criticising the update on 14th May.

The NHSE letter was not discussed with the BMA General Practitioners Committee before it was published. This letter serves as guidance – it has no contractual force. We are expecting further clarification from the BMA and GPC regarding this matter and will share it as soon as it becomes available. Please be assured that Humberside LMCs have made our NHSE regional team aware of how unhelpful and counter-productive we feel this letter is.

To ensure that practices are in full compliance with the terms of their contract they should be: 

  • Offering patients access to your practice via telephone/online and your reception is also open;
  • Offering patients face to face appointments based upon your assessment of clinical need following a discussion between the clinician and the patient;
  • Offering on-line access for a proportion of your appointments;
  • Offering a discretionary e-consultation (or equivalent) platform, which need only be during core hours Monday-Friday 08:00-18:30, and;
  • Providing information about your services via your practice website

Practices are not obliged to offer patients a face-to-face appointment solely upon their request. The relevant parts of the Regulations are as follows: 

Essential Services

4) The services described in this paragraph are services required for the management of a contractor’s registered patients and temporary residents who are, or believe themselves to be—

(a) ill, with conditions from which recovery is generally expected;

(b) terminally ill; or

(c) suffering from chronic disease,

which are delivered in the manner determined by the contractor’s practice in discussion with the patient.

(5) For the purposes of paragraph (4) “disease” means a disease included in the list of three character categories contained in the tenth revision of the International Statistical Classification of Diseases and Related Health Problems; and “management” includes

(a) offering consultation and, where appropriate, physical examination for the purposes of identifying the need, if any, for treatment or further investigation; and

(b) making available such treatment or further investigation as is necessary and appropriate, including the referral of the patient for other services under the Act and liaison with other health care professionals involved in the patient’s treatment and care.

Since March 2020, practices in the Humber area have remained open and continued to offer face-to-face appointments based on clinical need – this should not change, and the LMC will support practices to continue to practice in this way. The LMC is very aware that many GP colleagues, practice managers and practice teams do not believe they are now able to offer a consistently safe service to all patients. It is very disappointing that after all the efforts of the past year, general practice is experiencing unparalleled demand. 

This latest NHSE letter panders to the illusion that the NHS can meet the limitless pool of patient demand, rather than a service based on need, and throws general practice to the media wolves. It also ignores the continuing concerns about circulating Covid-19 variants, and the need to maintain appropriate infection prevention and control procedures.

The LMC will continue to work closely with the local CCGs and the NHSE regional team. Our system partners and PPGs need to better understand the detail and data behind the scale and challenge around GP access, patient demand and workload.

We would encourage all colleagues to prioritise their own health and well-being, and not sacrifice themselves (and their families) in an attempt to manage impossible, unlimited, patient demand.

Update 20/05/21

Richard Vautrey, Chair of the GPC has said in an update:

"Instead of knee-jerk responses to press headlines there needs to be proper acknowledgement from the Government and NHSE/I that practices are under huge pressure at the moment, that you are doing the right thing by working in line with national infection protection and control guidance as set out by the CMO and that you have been using telephone and online consultations appropriately to both keep patients and staff safe. This also needs to be much more clearly explained to the public."

"It is for practices to determine how best to manage and deliver their services and the best arrangements for appointments, based on their expert knowledge of their local community. Practices have the contractual freedom to do this taking in to account their capacity and workload pressures, and by doing so delivering a safe service to their patients."

"None of us trained to be call-centre GPs and we all want to get back to a time when we have the freedom to see more patients face to face but we need to do that in a way that matches capacity and safety within each practice. As covid-19 prevalence falls and, through the incredible efforts of general practice, vaccination levels rise practices are rightly and wisely adapting the arrangements they have had during the height of the pandemic. However, at present we know there is no spare capacity, there is no surplus workforce waiting to come and assist and the impact of the wider NHS backlog is having a massive impact on every practice. We know that Practices have been and will continue to offer face to face appointments for those patients who need them as well as trying to protect our patients and colleagues from becoming infected in our surgeries."

"We don’t just need our patients’ understanding, we have often had that throughout this last year, we need governments to act. We don’t just need short term fixes, or more letters and guidance telling us what to do, but a return to the freedom to deliver services in the way that best meets the needs of our patients, as well as long-term commitment to investment and development of general practice. That is what we will keep pushing for and what we expect government and NHSEI to deliver."

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