Calls for NHSE primary care lead to resign over 'insulting' face-to-face letter

NHS England's medical director of primary care is facing calls to resign in the wake of a widely-condemned letter ordering practices to offer all patients face-to-face care.

General practice is open (Photo: Kameleon007/Getty Images)
General practice is open (Photo: Kameleon007/Getty Images)

Pressure group GP Survival launched a petition late on 16 May calling on NHS England primary care medical director Dr Nikki Kanani to 'resign or be removed from her post'.

The campaign began just days after a letter from NHS England told practices: 'Patients and clinicians have a choice of consultation mode. Patients’ input into this choice should be sought and practices should respect preferences for face-to-face care unless there are good clinical reasons to the contrary, for example the presence of COVID symptoms.'

The letter, signed by Dr Kanani and director of primary care Ed Waller, has been widely condemned by GP leaders at the BMA and by LMCs, and has sparked criticism from doctors leading primary care networks. The letter comes just over six months after Dr Kanani was forced to apologise for an earlier letter warning GPs to offer face-to-face appointments, which was also widely criticised as 'offensive'.

Total triage

The NHS England letter came after attacks on GPs in the national media over reduced access to face-to-face appointments during the pandemic - a move adopted across the board in general practice as part of the 'total triage' approach endorsed by NHS England.

Despite the shift to total triage, however, practices have continued to see huge numbers of patients in person - with half of all appointments in general practice through the pandemic delivered face-to-face.

GP Survival said its petition had been launched in response to the 'inflammatory and insulting standard operating procedure sent to English practices last week, telling them they must offer face-to-face appointments to patients who prefer them'.

A statement alongside the petition said: 'Deliberately or not, it implies support to the false accusations in the press that GPs have not been providing face-to-face care throughout the pandemic.

COVID-19 pandemic

'GPs across the UK have worked tirelessly during the COVID-19 pandemic, delivering effective ongoing care to their patients at greater numbers than ever utilising telephone triage as per NHS England guidance, and seeing face-to-face in surgeries/hot hubs/home visits as needed, administering nearly 75% of COVID-19 vaccinations, and seeing many practice staff lost to COVID in the line of duty.

'It is insulting in the extreme to their memory to be told by a fellow GP that we must see patients face-to-face when there is ample evidence that we, as a profession, never stopped.'

The GP Survival petition comes after a wave of frustration in general practice over the stance taken by NHS England.

BMA GP committee chair Dr Richard Vautrey called the letter 'tone deaf' - and said general practice had been let down by NHS England and the government.

General practice is open

Local medical committees have also hit out at the letter, with one informing practices they are 'free to ignore any such guidance'. Berkshire, Buckinghamshire and Oxfordshire (BBO) LMCs said the letter 'adds implicit fuel to the falsehood being promulgated in the media and elsewhere that GP practices are somehow closed'.

A BBO statement added: 'GPs and their staff are exhausted and beyond breaking point. The constantly changing, contradictory and whimsical demands from NHS system leaders has to stop and it has to stop now.'

Londonwide LMCs issued a statement warning that practices had been working at levels in excess of their maximum capacity through the pandemic - and condemning criticism of practices for delivering care in precisely the way they had previously been instructed to do so.

Cambridgeshire LMCs advised GP practices in the area that the NHS England has 'no contractual force' - because practices are not contractually required to offer face-to-face appointments to patients irrespective of clinical need.

The LMC confirmed that the guidance issued by NHS England 'was not discussed in any form' with the BMA GP committee - and advises practices to 'delete it or file it as a memento to incompetence'.

Around 130 GPs had signed the petition within a few hours of the morning of 17 May. Comments from signatories included GPs saying they felt 'let down and betrayed', or 'profoundly demoralised' - and said the letter showed NHS England was 'pandering to the press and politicians'.

However, other GPs spoke out in support of Dr Kanani on social media, rejecting calls for her personally to resign.

NHS England said it had no further comment to add at this stage.

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