GPs and NHS England on collision course as winter crisis looms

The British Medical Association’s (BMA) collective action is a recurring theme in my work at the moment and with good reason – the BMA’s action is about to steam headlong into the NHS winter pressure plans.?

As part of those plans, GPs have just been told to avoid hospital admissions. Most of my customers couldn’t believe the NHS felt the need to point that out. Why would GPs admit anyone to hospital who didn’t need admitting? I have to say, I share their incredulity.?

The letter from NHS England says they should proactively identify and manage patients with complex needs and long-term conditions to try to actively avoid hospital admission.??

I think there’s real fears that we have all-year-round pressure on the NHS now. We used to call it winter pressure but now it’s plainly just constant. It pushes on to accident and emergency, ambulance response times and, of course, ambulance handover times when they get to A&E.?

Read my blog – Win over the NHS by helping to solve spiralling workload crisis – here?

General Practice is fighting for its life?

The BMA collective action, which now has a handbook, recommends a number of actions that General Practice should be taking to stop extra work being dumped on to practices.?

The NHS letter, which has been sent to integrated care boards (ICBs) and hospital trusts, highlights that they recognise winter pressure is likely to see urgent and emergency care services come under enormous pressure and strain and that in turn will result in patients facing longer waits at certain times than we would deem acceptable.??

The letter goes on to say all NHS organisations should ensure people are cared for in the safest possible place as quickly as possible.?

That requires a whole system approach, and the letter does recognise that – managing the winter demand involves every health and social care setting.?

BMA does not want to engage with Advice and Guidance?

It’s a real challenge because the NHS is saying the ICBs should be working with providers to ensure proactive identification and management of people with complex needs and long-term conditions, so their care is optimised ahead of that winter pressure.??

But we must keep in mind that the BMA balloted General Practice over taking collective action. This is a result of three years of contract imposition where they’ve had rises in General Practice funding which were well below the rate of inflation.?

It’s also worth remembering that when General Practice does get an uplift in its core contract, unless it also gets a corresponding uplift in Local Enhanced Services (LES), Local Incentive Schemes (LIS), locally commissioned services and Primary Care Network (PCN) funding, it’s actually not getting the 6% rise that’s been claimed this year by the Government, because that only affects the core aspect of what they do.??

The delivery of the letter runs headlong into the BMA telling its members: “Don’t engage with Advice and Guidance.” But Advice and Guidance is a core part of NHS England’s plans to keep work out of hospitals.?

GPs should not have to pick up extra work without more money?

NHS England is basically saying that when the hospitals offer Advice and Guidance, it helps manage non-urgent patients in the most appropriate setting and it then reduces unnecessary referrals into secondary care. That’s a key part of the plan to try to reduce the 30 million outpatient appointments that we have each year.?

But, rightly, the BMA has warned practices that Advice and Guidance just transfers a substantial proportion of outpatient work into General Practice, with no extra funding. And their view is that work should be funded through a Direct Enhanced Service, worth tens of millions of pounds a year.?

I agree with them – General Practice cannot be taking on secondary care work without any additional funding. I mentioned Lord Darzi’s review into the NHS on behalf of the government in one of my recent newsletters. He talks about what he calls left shift, shifting work out of hospital, but he highlights that needs to come with the money and resources to make that happen.??

It’s worth noting that the National Audit Office highlighted that Advice and Guidance is basically dumping work onto General Practice much faster than expected, based on what they called very limited evidence.?

They also said it may not have any impact or reduce the NHS backlogs anyway, so you can’t help wondering what the value of it is.??

The battle lines are drawn?

The practices have been told by the BMA to stop engaging with Advice and Guidance as part of the 10 forms of collective action the BMA England GP Committee has recommended so it will be really easy for General Practice to refuse to abide by this letter and interesting to see what actually happens.?

The BMA is telling its members that Advice and Guidance is neither contractual nor a professional obligation. It also warns that the NHS electronic referral service only enables referrals from some trusts via the advice route.?

At these trusts, if the GP requires a specialist review and not advice, they should provide full information required for a referral and state that the request is for a specialist to provide the patient with a consultation.??

So, they’re being told to be really clear that they are not asking for Advice and Guidance. They’re making an actual referral and they want the patient seen.?

What they’re also saying is if, despite that request for an appointment, the patient has then been offered Advice and Guidance, they should respond stating the original request was for a referral, it wasn’t a request for advice.?

In short, we’re in for a tough winter. Everybody’s forecasting that the rising pressure on services will mean there’s no easy way out of this.?

The NHS has got too much work. It doesn’t have the people to meet the demand and there’s a real need for innovation. This letter from NHS England isn’t particularly helpful or innovative, and we’re reaching a point where the Government must sit down with the BMA and thrash out a proper deal for General Practice.?

Hopefully that’s what lies ahead.?

Scott McKenzie helps pharmaceutical, medical technology and device firms get their products and services in front of the right NHS decision makers. He helped to land no fewer than 53 new projects with the NHS in 2023 alone and has now developed a 12-month mentorship programme that helps individuals and teams get straight to the heart of the challenges of selling to the NHS. If you want to get your products fully embedded into treatment pathways, Scott can help. Get unprecedented access to key customer insights, proven tools, resources and strategies plus 1-2-1 coaching and decision-maker introductions to finally get your project over the line. Find out more here.?