GP practices have been advised they ‘can remove themselves temporarily’ from the NHS Directory of Services to cope with ‘extreme’ pressures.
Lancashire and Cumbria consortium of LMCs published guidance for practices struggling with extreme workload, as they said they have been receiving requests from constituents asking what practices can do within their contract to try and safely manage patient care.
The guidance provided a list of measures that practices can put in place within their contracts, including amending their entry on the NHS Directory of Service, re-triage patients allocated by 111 and move to 15-minute appointments immediately.
The LMC said that if an individual clinician is dealing with more than 25 patient contacts a day, they are operating at a level that impacts patient safety and automatically rated ‘red’ using the risk ‘RAG’ rating system.
Practices are required to make one appointment per 3,000 registered patients per day available for direct booking by NHS 111, but the LMC said that temporarily amending their DoS entry after a ‘red’ RAG rating means the practice will not show up as available for direct NHS 111 booking.
It said: ‘The current pressures on general practice are extreme, and GPs are being faced with unmanageable, unsafe workloads.
‘Practices can remove themselves from the DoS temporarily if necessary. This will stop 111 booking into GP appointments slots for a certain amount of time and 111 will have to re-direct patients to other green options.’
The LMC reassured practices that none of these measures would put them in breach of contract, adding: ‘They are recommended by the BMA GPC, and as your LMC we advise you take heed of the published advice as appropriate depending on your current pressures.
‘If you are being placed under pressure by anyone within our local system or told that you cannot put these measures in place, please contact us, and direct them to the LMC. We will manage these conversations on your behalf.’
Faye Tomlinson, chief operating officer for the consortium of LMCs, told Pulse: ‘The guidance says that if a practice has rated themselves as red then they will no longer be presented as an option on the DoS.
‘This is NHS guidance that we are sharing with our practices to support them in managing extreme workload pressures that won’t affect their contract.’
She added: ‘We felt that we needed to put something out to practices to reassure them around what contractually they can do – quite often there would be concerns around taking certain measures.
‘Removing themselves from DoS is only a temporary measure – if they are rating themselves as red, this is a way to ensuring that they don’t have more work that could potentially increase their workload.’
At the beginning of the month, Pulse reported that NHS 111 had been asking GP practices in Wessex to take on extra patients beyond agreed slots, according to local medical committees.
I can’t see anyone respecting this. 111 do what they want.
Our 111 slots were full so 111 just emailed the practice with their ‘2 hour’ disposition. No knowledge of whether we would check it or have capacity to review the patient. No telling the patient to seek help with us.
No harm done, this time, but wrong on so many levels!
How can a 2 hour disposition be a GP issues? A/E can’t see patients in 2 hours!
I’ve also tried to get the directory of services updated so minor injuries are directed to where minor injury funding, contracts and expertise is – minor injuries units, but apparently this is ‘impossible’ to update for one practice alone in London. I’m still awaiting response to my multiple follow up emails from 2019 about this – it was going to be taken to a meeting and they would get back to me.