NHS England has attempted to allay concerns raised by GPs around contract changes which will mandate practices to keep online consultation tools open during core hours.
From October, all practices will be contractually required to keep their online consultation tool open from 8am to 6:30pm for ‘non-urgent appointment requests, medication queries and admin requests’ as part of changes to the 2025/26 GP contract.
The new requirement has already prompted concerns from GPs, who have said that this ‘will not solve the 8am scramble’, and could instead cause patient safety issues and an increase in workload for practices.
Yesterday evening, during a webinar on the contract changes, NHS England’s primary care director Dr Amanda Doyle received several questions from GPs about this change, which was branded ‘unsafe’ and potentially leading to staff ‘burnout’.
In response, Dr Doyle clarified that practices will need to monitor requests during core hours but not necessarily deal with each one on the same day.
Dr Doyle said: ‘All practices are going to have to have their system whereby the reception or other staff are monitoring online requests in the way they do now, but throughout core hours.
‘But every single question that comes in doesn’t have to be dealt with that day. If someone sends a medication query or a routine appointment request at quarter past six, there’s no expectation that you get back to them immediately with that.’
She added that this requirement was ‘something ministers were absolutely set on’ during the contract negotiations.
She added: ‘There is an expectation these days from the public that you can access services using online means, and it seems unreasonable in many ways that that isn’t the case for general practice, and that [online consultation tools] are switched off in an inconsistent way.
‘So that’s one of the frustrations. It can shut at lunchtime. It can shut at a different time each day. So this is about letting people contact to ask for routine, non-urgent appointments and to put queries in at any time when the practice is open.’
NHS England also said that it’s ‘absolutely fine’ to have messages on practices’ websites and systems which tell patients that if they think they need to be seen ‘urgently’, they ‘should ring the practice and speak to someone’.
GPs attending the webinar also raised concerns around QOF changes which will be implemented as part of the contract, and whether NHS England is looking at other ways to performance-manage practices in those areas.
As part of the new contract, NHS England will remove 32 QOF indicators and invest their funding into global sum, childhood vaccinations, locum reimbursement rates and cardiovascular prevention.
These 32 QOF indicators, including establishing and maintaining registers of cancer patients, and of patients with a learning disability, dementia, heart failure, hypertension and arterial disease, will be ‘permanently retired’, equating to 212 QOF points worth around £298m in 2025/26.
Dr Doyle said that NHS England is looking at ways in which it can ‘monitor and benchmark’ clinical quality of care without having a ‘specific measurable indicator’.
She said: ‘Just because we are not financially incentivising something doesn’t mean that we don’t expect patient practices to still deliver clinical care to the same quality that they were doing before.
‘We are looking at ways in which we can monitor and benchmark clinical quality of care without actually having to have a specific measurable indicator.
‘So we’re we are keen that what we don’t see is a fall-off in quality of care once we remove payments for indicators, and so we will be continuing to monitor, but certainly there’ll be no expectation of practices, and we’re not looking to introduce a different sort of performance management in the same way.’
The new contract also includes a new enhanced service worth £80m to fund advice and guidance (A&G). But Dr Doyle said that NHS England is ‘not looking for it to just suddenly explode through the roof’.
She said: ‘If you don’t think that there’s any benefit to you or your patient in using advice and guidance, don’t use it.
‘Obviously the money will cover those you were doing anyway. It’ll cover all advice and guidance, but this is about where there are benefits to patients and where they can get consultant input much more quickly than waiting a long time for an outpatient appointment, and this is a way to do that.
‘But there’s no suggestion it has to be advice and guidance that avoids a referral. If the right thing to do is continue to refer at the end of the day, then that’s fine. You still get paid.’
The A&G funding is limited nationally to £80m, but it will be up to ICBs ‘how they apply that’, Dr Doyle added.
She added: ‘We have told ICBs we will be removing from secondary care budgets to pay for it, and we’ve divided that up by ICB so that they know the amount of their secondary care allocation that will be removed to pay for this.
‘An ICB can cap it at that level. It can’t cap it beneath that level, but lots of ICBs have suggested they might not want to cap it, so we’re not putting national rules in this.’
Dr Doyle also clarified that there is ‘no intention’ to scrap PCNs, following concerns that funding is only going to be renewed for one year.
She said: ‘We seem to get this every year. People get really caught up about [it]. “It’s only a one year thing, so therefore how do we know there’s a future?”
‘We get a one-year budget every year for the entirety of the service. It doesn’t mean we don’t intend it to continue. It’s just that we don’t know how much money will be available in future years or what we can commit to, so there is no intention to not continue to support PCNs.
‘We’re very clear that there are lots of services that benefit from being delivered at a bigger than single practice scale. There’s no threat in any of this to working on the PCN scale.’
The contract changes, including almost £800m being invested into the global sum, were agreed in a deal ‘in principle’ with the BMA’s GP committee.
Today, GPC chair Dr Katie Bramall-Stainer wrote to health secretary Wes Streeting to reiterate the the committee’s demand for a written confirmation of the Government’s commitment to negotiate a new ‘substantive’ GP contract within this parliament.
She also said she had ‘greatly appreciated’ the Government’s ‘constructive approach’ during recent negotiations and said she was looking forward to this continuing in the upcoming review of ‘accessing appointments online, ARRS and GP Connect Update Record’.
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Unfortunately patient expectation because Wes said so is that they fixed the scramble to be seen by opening up online access the expectation will remain but they are dealt with in some form or other same day who knows there will be many who mistakenly believe they now have the right to be seen on the day- the advice and guidance aspect of things seems at best confused- our ICB (Integrated Care Board) hasn’t got two shekels to rub together and secondary care we would be very reluctant To play far on this if they perceive funding as being removed- I haven’t seen enough detail to be assured this will be a step forward this year
I am going to repeat more doors on the bus does not increase it’s seating capacity and may even reduce it