Primary care standard operating procedure scrapped as COVID-19 rules relaxed

The standard operating procedure (SOP) for primary care has been withdrawn as part of changes to COVID-19 rules from 19 July.

NHS drops GP operating procedure (Photo: Mike Kemp/Getty Images)
NHS drops GP operating procedure (Photo: Mike Kemp/Getty Images)

The decision to withdraw the document, which has underpinned what the BMA has called a 'top-down approach' and 'micromanagement' of general practice during the pandemic, was confirmed in a letter this week from NHS England.

The letter setting out 'arrangements for primary care from 19 July 2021' says that several SOP documents in force throughout the pandemic have now been withdrawn, including the one setting out expectations of general practice.

Despite the withdrawal of the SOP, NHS England makes clear in its letter that practices 'should continue to offer a blended approach of face-to-face and remote appointments, with digital triage where possible'.

Face-to-face access

The SOP has been at the heart of disputes between general practice and NHS England over face-to-face access to general practice throughout the pandemic, with many GPs feeling that NHS leaders have fuelled a false narrative in parts of the media that general practice has been 'closed'.

Talks remain suspended between the BMA's GP committee and NHS England after an update to the SOP in May this year called for practices to offer face-to-face appointments to all patients that wanted them - triggering a vote of no confidence in NHS England's leadership.

At the time, the BMA's GP committee chair Dr Richard Vautrey said the SOP update was 'woefully badly judged' - and the 'final straw' for GPs who had worked through intense pressure during the pandemic. The Leeds GP said at the time that GPs had 'continued to provide care for their patients under the most difficult circumstances, only for their efforts to be undermined and instead issued with a public rebuke which also inferred that surgeries had been closed to face-to-face appointments'.

GPs' fury over the update to the SOP came because the document, introduced in March 2020, itself set out requirements for GP practices to reduce face-to-face contact with patients and adopt total triage to limit the spread of COVID-19 at the outset of the pandemic.

COVID-19 pandemic

GP practices adopted this approach and shifted rapidly to delivering large numbers of consultations remotely - while also delivering half of all appointments throughout the pandemic in person.

The call for all patients to be offered face-to-face appointments was not the first time that GPs had clashed with NHS leaders over access during the pandemic, with NHS England's primary care director - who faced calls to resign this year - also forced to apologise in September 2020 after an letter that reminded practices of their duty to see patients in person and warned that a failure to offer appropriate care may constitute a breach of contract.

GPs at the time called the NHS England letter 'erroneous and offensive', and warned that it had triggered a wave of abuse for practices.

NHS England's letter confirming withdrawal of the SOP also makes clear that most services suspended in the pandemic have now been reinstated - such as the QOF, which officials have said there are no plans to suspend again this year despite continuing intense pressure on general practice.

Suspended requirements

A requirement for practices to report to commissioners about Friends and Family Test returns, however, remains suspended. Temporary suspension of 'the requirement for individual patient consent in certain circumstances, to encourage increased use of electronic repeat dispensing also remains in place, along with the temporary increase to the number of appointment slots practices must make available for direct booking by 111 - which remains at one slot per 500 patients per day.

The letter adds: 'We will review these direct booking arrangements with key partners in the context of wider discussions on GP access, with a view to ensuring that they are not extended beyond the necessary period.'

It also confirms that the requirement to 'offer medication reviews face-to-face under the Dispensary Services Quality Scheme will continue until at least 1 October 2021'.

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