The instruction to practices came ahead of an emergency BMA GP committee meeting that will discuss how the profession should respond to measures set out by the government and NHS England last week that demand more appointments, more face-to-face access and impose new performance management in return for a share of a £250m winter access fund.
In an update to practices on 20 October, Cambridgeshire LMC told practices they would find 'nothing to support general practice' in plans that had been billed as a 'support package' for the profession.
'No-one can seriously believe the measures outlined by NHS England will encourage the recruitment, retention, or morale of general practitioners, or improve the care that can be provided to our patients,' the update said.
GP access
It argues that 'participation is not mandatory at a practice or PCN level', informing the profession: 'GPs do have a choice: none of these proposals are written into your contract, and on none of these targets can your practices be performance managed.'
It continues: 'You are under no obligation to respond to any requests for meetings, discussion, reflection, analysis or to provide any commentary if the CCG contact you about what will be the inadequate data which they are obliged to rely on. We enclose an LMC template letter that you might find helpful to use.
'At this point the LMC does not recommend practices engage with this initiative or respond to it. It has no contractual standing and there is no requirement to do so.'
The BMA's GP committee has also said practices should not engage with the plans. The committee's chair Dr Richard Vautrey said: 'We are mindful that practices, following last week’s announcement will be asking what they need to do in the immediate future in response to the package of measures on offer.
GP workload
'GPC will be meeting later this week to discuss precise recommendations, and until then we’d urge GPs to continue to dedicate their time to the usual business of the practice and looking after patients, and not focus on the plans in any meaningful way.'
Cambridgeshire LMC met with integrated care system and CCG leaders in the region earlier this week and told them it was 'simply not feasible to expect our GPs and practice teams to deliver more', warning that there was 'no more left to give, and there is no workforce available to provide it'.
However, the LMC said that calls in the support package for 'increased access to urgent, same day primary care, ideally from patients’ own GP services' could be delivered with a concerted effort to strip out workload dumped on primary care by hospitals.
Citing evidence from a workload capacity analysis published last year by the LMC, it said GPs were spending 'an additional 8.6 hours/10,000 patients delivering acute and community trust activity'.
The 'plan for improving access and supporting general practice' published last week has been condemned by both the BMA and the RCGP. It includes a £250m winter access fund, to be rolled out between November this year and March 2021. The funding is explicitly linked to demands for practices to deliver more appointments overall - at a time when the profession is already delivering more than ever before - as well as demands for more appointments face-to-face.
The plans will also create new QOF targets on access for GP practices, and could bring the rollout from April 2022 of a new patient satisfaction system that will invite patients to rate their practice by text after an appointment.
Satisfaction scores will be published at individual practice level alongside practice-level data on 'activity and waiting times', the plans confirm. Practices will be incentivised under the Investment and Impact Fund to increase their satisfaction scores in 2022/23, with the scale of incentives to be 'increased significantly in 2023/24'.
GP leaders warned the plans threatened to drive up pressure on general practice - and could lead to yet more abuse in the wake of sustained attacks over face-to-face access. The plans come just weeks after GPs hit out at the government for 'singling out' general practice for pay transparency measures that will not apply to any other NHS employees or contractors - despite promises that GPs would not be unfairly targeted.
