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GPs could clash with NHS 111 call handlers

Retendering contracts will cost tens of millions of pounds

Adrian O'Dowd

Friday, 03 January 2014

Doctors’ leaders have warned that GPs will refuse to be “dictated to” by non-clinical call handlers working for the medical triage helpline NHS 111.

An investigation published online today in the BMJ has found there are tensions between the BMA and senior civil servants over plans to give patients who dial NHS 111 the right to demand contact from a GP at their registered practice.

The BMJ obtained e-mail correspondence between senior figures at NHS England that reveals an intention to insert new clauses into GPs’ contracts that would allow breach of contract notices to be served to GPs who fail to see or speak to with patients that have been diverted from NHS 111 call centres.

The BMA said any plans to alter GPs’ contracts would be strongly resisted, because they would add additional pressure on already overstretched practices and would allow remote lay call handlers to dictate to clinicians on whether patients should be seen.

NHS 111 faced problems with staff shortages, treatment delays and ambulances being summoned unnecessarily when it launched at Easter 2013. In July of last year, NHS Direct, which was providing the service to around a third of England, pulled out of all its contracts, after admitting it could not afford to operate the service.

NHS England says the service has overcome these initial problems, and is now providing a good service to patients.

However, a significant cost is likely to be borne in correcting the initial problems, running to tens of millions of pounds.

One commissioning body alone has estimated that its re-procurement process will cost £500,000 and 13 contracts are due to be re-tendered. NHS England has invested an additional £15m in funding to shore up 111 services this winter.

CCGs have been told not to retender any 111 contracts until 2015, with contracts previously held by NHS Direct being transferred to temporary “step in” providers, the majority of which are ambulance trusts.

For the investigation, the BMJ obtained details of the financial terms offered for 27 of the 46 NHS 111 contracts currently in operation via a Freedom of Information request.

Across the 27 areas that did provide data, commissioners awarded contracts worth more than £320m to service providers. This included £150m for contracts which began in April 2013, but which will have to be re-tendered following NHS Direct’s withdrawal.

Dr Peter Holden, lead negotiator on NHS 111 for the BMA’s GP committee, warned that obliging GPs to see patients directed to them from NHS 111 could overburden GP practices.

“We’re already seeing 60 to 70 patients a day. We cannot do any more safely. We are absolutely saturated,” he said.

“We said quite clearly, there’s no way we are going to be told that we are obligated [to see patients sent via NHS 111]. What we do is re-triage [patients] and decide what we’re going to do. But we are not going to have some lay operative working a computer programme telling us how to practice medicine.”

A spokesperson for NHS England said GPs were required to “care for patients as necessary” as part of their contractual terms.

The spokesperson said: “We are working with the BMA to consider a joint statement which ensures practices make sure they meet this obligation. This is vital if a patient has been triaged through the clinical algorithm and the practice can respond with appropriate and timely clinical response.”

DOI: 10.1136/bmj.f7659

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