NHS England outlines tighter core hours opening rules for GPs

NHS England officials have given the first indications of how core hours opening requirements for GP practices could be tightened under the 2017/18 GP contract, and ruled out a 'big bang' contract reform in 2018/19.

NHS England director of primary care Ros Roughton told MPs at a House of Commons public accounts committee hearing on Thursday that she believed clearer guidance should be 'written down' on core hours opening rules.

Officials told MPs that the NHS would move away from the traditional 'high trust' system that has relied on GP practices to make their own decisions about how they interpret contractual requirements around opening times.

Under the current GMS contract, GP practices are not required to be open throughout core practice hours of 8am to 6.30pm, but must provide essential services to meet the 'reasonable needs' of their patients.

GP access

Asked by MPs at the PAC hearing to give a definition of the 'reasonable needs' of patients during core hours, Ms 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.'

She highlighted that NHS England had agreed as part of the contract deal to talk with the BMA and LMCs on core hours opening, adding that writing down the rules would mean 'everyone can feel confident in applying those rules'.

NHS England chief executive Simon Stevens told MPs that 'about 75% of the half-day closures are concentrated in about a quarter of CCGs'.

GP contract

'So there is geographical targeting we need to do in practices in those areas,' he said. 'We are now following up with practices in those geographies. From October the GP contract is going to change and practices will no longer be eligible for that enhanced service payment if they have on a weekly basis half-day closure.'

But earlier this year GPonline revealed that one in seven practices in England could face longer opening to avoid losing £8,000 on average in extended hours funding, after changes announced as part of the 2017/18 GP contract deal.

The new deal says that from October this year practices that regularly close during core hours will not usually qualify for extended hours funding, in a crackdown prompted by a high-profile National Audit Office (NAO) report published in January.

The NAO report said 18% of GP practices in England close at or before 3pm on at least one weekday, and that 76% of these received extended hours DES money - worth an average of £8,224 per practice.

Some senior GPs have criticised the lack of detail on how changes to extended hours funding eligibility will operate, despite assurances from the GPC executive that only small numbers of practices would be affected. The RCGP has called for clear guidance on how any changes in interpretation of the rules will affect practices.

Mr Stevens also told MPs that allocation of primary care funding at CCG level was 'probably fairer now than at any point since 1948', saying the NHS had made 'dramatic strides' in improving equity in recent years.

He said this process was being extended to the GP contract. '[The Carr-Hill formula] was a source of great controversy and consternation and was almost enough to topple the GP contract when it came out in 2004 in the first place,' the NHS England chief executive told MPs.

'Everyone wants to tread with care when they are messing with things that will produce big swings in income for individual practices. We are moving to a fairer situation around the MPIG, that has had to come in over seven years so as not to have that big dislocating effect at practice level, and reviews of personal medical services are being phased in over four years.

'We have committed in principle to phasing out the QOF bit of the GMS contract, which in my view now has run its course. As part of the discussion about replacement of the QOF element, we also have to look at what this Carr-Hill piece would be, but I don’t think we should throw all the cards in the air and it would be a big bang that would destabilise practices in 2018.'

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