Breach of contract threat 'insult to GPs' delivering 300,000 face-to-face appointments a day

GP practices have been urged to remind patients that face-to-face appointments remain available during the pandemic, in a letter from NHS England warning that failure to offer appropriate access may constitute a breach of contract.

RCGP chair Professor Martin Marshall (Photo: Pete Hill)
RCGP chair Professor Martin Marshall (Photo: Pete Hill)

The NHS England letter says 'the vast majority of practices have made significant efforts to remain accessible' during the pandemic, but highlights reports that some patients are 'experiencing difficulty in accessing their GP for needed face-to-face appointments'.

A communications toolkit is being rolled out to practices to help them remind patients that face-to-face access is possible, NHS England says.

But the letter makes clear that practices could face enforcement action if they fail to offer clinically-indicated face-to-face appointments - reiterating a warning earlier this year that this could constitute a breach of contract.

Insult to GPs

The letter has brought a sharp response from the RCGP - with the college citing data showing that 'each and every day last week an estimated third of a million appointments were delivered face-to-face by general practices across the country' despite the ongoing pandemic.

College chair Professor Martin Marshall said any implication that practices had 'not been doing their job properly is an insult to GPs and their teams who have worked throughout the pandemic, continued delivering the vast majority of patient care in the NHS, and face an incredibly difficult winter ahead'. BMA GP committee chair Dr Richard Vautrey called the suggestion that face-to-face appointments had been on hold 'an affront' to GPs.

GPonline reported earlier this year that by July, face-to-face appointments being delivered in primary care were up 70% compared with the early stages of lockdown in the UK.

Face-to-face consultations have continued to grow as a proportion of overall GP workload in recent weeks - with overall workload now at a level in excess of last year, and still potentially underestimated in surveillance data.

Access to GPs

However, the NHS England letter warned that some patients are reporting that face-to-face appointments are not available. It said: 'It is important that no practice suggests in their communication that the practice is closed or that the practice is not offering the option of face-to-face appointments.

'We will continue to provide public messaging through the media and campaign materials which explain how patients can safely access healthcare services and the importance of coming forward with any health concerns.

As would normally be the case, local commissioners will investigate any complaint from a patient that they are being refused face-to-face consultations when there is an identified need, or that they are being directed to emergency departments inappropriately.'

Professor Marshall said: 'General practice is open and has been throughout the pandemic. GPs have been delivering a predominantly remote service in order to comply with official guidance and help stop the spread of COVID-19.

Winter pressure

'Any implication that they have not been doing their job properly is an insult to GPs and their teams who have worked throughout the pandemic, continued delivering the vast majority of patient care in the NHS, and face an incredibly difficult winter ahead.

'As well as delivering routine care to patients with both COVID and non-COVID conditions, GPs have been working in COVID "hot hubs", identifying those at most risk from the virus and advising them on how to stay safe, and supporting NHS 111 and other areas of the NHS.'

The college chair said that 'where face-to-face appointments are necessary, they are being facilitated' - and urged CCGs to work with practices where a large proportion of staff were at high risk from COVID-19.

He added: 'The college does not want to see general practice become a totally, or even mostly, remote service post-pandemic. However, we are still in the middle of a pandemic. We need to consider infection control and limit footfall in GP surgeries – all in line with NHS England’s current guidance.

'GPs and our teams are currently preparing for a potential second wave of COVID-19 and to deliver an expanded flu vaccination programme to almost double the number of patients we usually do - this is in addition to delivering care to around a million patients every day, including those with conditions directly or indirectly related to the COVID-19 virus.'

NHS England medical director Dr Nikki Kanani said: 'While many people, particularly those most vulnerable to COVID-19, want the convenience of a consultation over the phone or video, the NHS has been and will continue to offer face-to-face appointments and I would urge anyone who feels they need medical support to come forward so they can get the care, support and advice they need – the NHS is here for you.'

Dr Vautrey said: 'GPs have been working incredibly hard to keep their services as accessible as possible during the COVID-19 pandemic, with most offering virtual triage as the first point of contact in order to help keep their workforce and communities safe. This is exactly what the government has been encouraging them to do.

'This does not mean practices have stopped face-to-face appointments, and they continue to be offered where safe and necessary. Any inference that in-person consultations were put on hold is an affront to the committed GPs who have continued to go to work throughout the pandemic.'

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