MPs set one-year deadline for NHS to define core hours GP services

NHS officials have been told by MPs to define by March 2018 what services practices should provide during core hours.

A report on GP access by the House of Commons public accounts committee said NHS England should report back to it in 12 months with a definition of what patients should expect to be available between 08.00 and 18:30. MPs said officials should explain how they will ensure commissioners contract-manage practices to meet the requirements.

Under the GMS contract practices are not required to be open throughout core hours, but must provide essential services to meet the 'reasonable needs' of their patients.

The public accounts committee criticised the GMS contract for not clearly setting out ‘what patients should reasonably expect from their practice during core hours’.

GP contract

‘To date local commissioners have not had a consistent view on how to define the reasonable needs of patients, particularly as this has never been written down and agreed,’ it said.

NHS England, it said, had accepted reasonable needs such as appointment booking or prescription collection should be written down and would work with the BMA to complete this work.

Appearing before the committee in March NHS England director of commissioning Rosamond Roughton said: ‘'I think that definition means you should be able to phone your practice and book an appointment, pick up a prescription, drop off a specimen.

'If results come into the practice that require urgent attention there should be someone there to pick that up - if it’s to do with your warfarin monitoring for example, there should be someone there to contact the patient. I think we need to write that down.'

Under the 2017/18 GP contract practices that regularly close during core hours from October will not usually qualify to deliver the extended hours DES. The GPC has said the change will affect only practices that close for half a day on a weekly basis.

GP opening hours

The public accounts committee called for NHS England to report in September on how it has ensured that practice opening hours are reasonable.

The committee said concerns it first raised a year ago over patient access to GP services persist. MPs said the DH and NHS England were rolling out extended hours ‘without really understanding the level of access currently being provided or how to get the best from existing resources’. There was a risk, it said, that new extended access services could cost 50% more than the core hours services and duplicate existing out-of-hours provision.

MPs called for NHS England bosses to report back in 12 months on how it is ensuring CCGs deliver ‘the wider benefits intended from extended hours funding and minimising any duplication of funding’. The committee also criticised the lack of progress on increasing GP numbers. 

GPC chair Dr Chaand Nagpaul said: ‘This is yet another important report that highlights that general practice is under incredible strain with many GP practices struggling to cope with rising patient demand in a climate of stagnating budgets and staff shortages.

GP workforce

'The latest workforce figures showed that last year there was a decline in the number of full-time GPs working in the NHS. The promised recruitment of 5,000 extra GPs remains a pipe dream that shows little sign of materialising in the next few years. Precious resources are being diverted to offer routine weekend appointments in some parts of the country when at the same time many GP services are struggling to provide effective, safe care to their patients during weekday opening hours and in urgent care settings in evenings and weekends.'

RCGP chair Professor Helen Stokes-Lampard said: 'GPs and our teams are working flat out to deliver more patient consultations than ever before – recent research has shown that our workload has risen 16% over the last seven years. The fact that patients are finding it difficult to make an appointment is not because we are not working hard enough, it is because we don’t have the resources and workforce necessary to deliver the care and services our patients need and deserve.

'It is also not the case that just because face-to-face surgeries might not be taking place, patient care isn’t being delivered via telephone or online consultations, or by GPs making home visits – and when a practice is temporarily closed, adequate cover arrangements will be put in place.

'We agree with the report that forcing GPs to work 8am to 8pm, seven days a week, regardless of patient demand makes little sense and is not cost-effective.'

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