'Non-essential services and unfunded work and requests to practices'
What do patients receive on the NHS from General Practice?
Defining ‘needs’ and ‘wants.’
As CCGs, the Sustainability and Transformation Plans (STP) and Better Care Together Programme seek to move work out of hospitals into a primary care setting (left shift). There is a concern that CCGs may no longer wish to pay for certain services which they consider to have become, as result of changes in clinical practice or by custom and practice, part of what GPs are expected to provide under ‘essential services.’
This issue is hindered by the imprecise definition of ‘essential services’ in the GMS contract. This has perpetuated ambiguity about what GP practices are expected to provide routinely to their patients.
Acute capacity problems in our surgeries are aggravated by substantial reductions to practice funding with the loss of MPIG, FDR and PMS Premiums. It is vital that we reach an understanding with CCGs as to whether, how, and when General Practice will agree to the transfer or continuation of work.
The three categories of general practice work:
- ‘Locally core’
‘Core’ General Practice
This is work that all GPs have a contractual duty to provide to their NHS patients. Practices are paid for this in their standard (core) NHS contracts.
‘Non-core’ General Practice
This is work that GPs may provide with or without additional funding. It is imperative that the people and tools are in place to provide such work safely and effectively.
‘Locally core’ General Practice
This is work that may be undertaken in a General Practice or community setting that, within a particular locality, has effectively become ‘core’ General Practice. For example, GPs within a locality may provide services:
- that are undertaken without additional payment if it has been previously agreed that the ‘locally core’ work did not involve significant extra commitment; or that the ‘locally core’ work was bound up with services that were generally accepted as ‘core’ General Practice.
- that were historically funded in some way, although the source of this funding might not be clear now.
To be accepted as ‘locally core,’ there needs to be a local consensus among GPs that the service in question will be properly and reasonably carried out by GPs and accepted as ‘good practice.’ Problems tend to arise when something viewed as ‘locally core’ does not have any contractual funding or explicit agreements for the quality of services.
Should a practice take on new work or continue to deliver services that are no longer funded?
General Practices need to consult with patients and carers to discuss which non-essential services are offered to explain what is funded by the NHS i.e. to prioritise needs over wants. LLR LMC’s opinion is that practices need to assess the true costs of what is involved and to assess whether such provision is economically viable and safe for their patients. GPs are required to provide reasonable access and continuity for their patients as the key tenet of their contracts. If this is jeopardised by additional tasks, requests and workload, GPs may be found to be in breach of their contracts or fail in their duty of care (as required by the General Medical Council).
Please get in touch with us if you are concerned about ‘non-core’ General Practice or ‘locally core’ General Practice for which you are not being funded or that you believe is inadequately funded – especially if you are finding that provision of such work impacts on your capacity to deliver contracted services to your patients email@example.com
We are proposing to develop some literature and posters to explain to patients which requests for forms, certificates and services are not part of what patients or carers are entitled to on the NHS. Such work undertaken during NHS time could have an impact on NHS services to patients – in many cases, there is a need to explain that there is a fee for private consultation times and for the issuing of forms or paperwork.
Please feel free to use and adapt any of the contents of this letter and the table that follows. It is important that you ask us to review any information that you prepare prior to sharing it with your team or with your Patient Participation Group in order for us to back you. You may wish to use this information to explain decisions or practice policy to patients and carers on your practice website or on any posters, leaflets or communications that you circulate to your patients.
Your LMC is here for you – please use us.
Table: Non-essential services and unfunded work and requests*
*courtesy of Dr Kieran Sharrock at Lincolnshire LMC