Welsh GP contract maintains 'total triage' - in stark contrast to Westminster approach on access

GP leaders in Wales say a revamped contract for 2021/22 that effectively maintains a 'total triage' approach to appointments and brings a 3% pay uplift will 'go some way to support practices under great duress'.

Welsh contract: blended access model (Photo: sturti/Getty Images)

The contract brings a 3% pay uplift for GPs and all practice staff - in line with the NHS pay rise for 2021/22 and exceeding the award for practices in England.

Additional funding is also announced for winter pressures, protected learning time and on data legislation to 'de-risk general practice'.

On access, however, the deal marks a significant departure from the approach to access and capacity in general practice in England - and an acknowledgement that GP capacity to deliver face-to-face care is limited.

Face-to-face appointments

In stark contrast to health and social care secretary Sajid Javid's statement in the House of Commons earlier this year that GP practices should offer face-to-face appointments 'to anyone who would like one', the Welsh contract aims to 'ensure people are triaged appropriately and if an appointment is needed, people receive one, which is right for their clinical needs'.

Arguably, the Welsh line is simply closer to the existing wording of the GMS contract - which states that appointments should be 'delivered in the manner determined by the contractor’s practice in discussion with the patient'.

A BMA Wales spokesperson confirmed the approach outlined in the contract deal was similar to the total triage model adopted in England early in the COVID-19 pandemic - and that it recognised that practices' capacity to provide appointments - including face-to-face or via other methods - was limited by workforce and workload pressures.

Repeated criticism of general practice over face-to-face care during the pandemic - which has come despite more than half of appointments being delivered in person - prompted a warning from RCGP chair Professor Martin Marshall earlier this year that face-to-face appointments on demand were simply 'undeliverable'.

Blended access

BMA GP committee chair for Wales Dr Phil White said: 'We welcome Welsh government’s commitment to step up public messaging around the blended model of access. GPs and their teams want to provide the very best access they can for patients – often working way beyond their contracts to do so - but it is crucial that patients understand the pressures facing the profession and what the existing workforce can realistically deliver.

'Put simply, there are not enough GPs working in primary care to manage current levels of demand. What this means, is that patients will be signposted to alternative services if they are deemed more appropriate and may have to wait to see their GP when they need to.

'We believe that the Welsh government understand the existential challenge GP practices face, and we are committed to continuing to work together to ensure that patients can access a better resourced general practice service in the future.'

The Welsh government echoed a promise made several years ago by former Westminster health and social care secretary Jeremy Hunt to 'end the 8am scramble for appointments'.

GP contract

Welsh health minister Eluned Morgan said the 'revised contract will make it clear the practice of releasing appointments daily at 8am is no longer acceptable' - adding that the contract had brought a 'way forward to improve the appointment system'.

She added: 'We know GPs and their staff are under significant pressure at the moment. They have played a really important role during the pandemic.'

Dr Phil White added: 'We are pleased that our collaborative working relationship with Welsh government and NHS Wales has resulted in a contractual agreement which we hope will go some way to support practices under great duress.

'The contractual arrangements in place for 2021/22 will see GPs and their staff rewarded for their extraordinary efforts during a time of unprecedented demands. The investment will enable the DDRB recommendation of a 3% uplift for GPs and their staff to be met.'

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