In November 2017, NHS England issued guidance to commissioners on how practices meet the ‘reasonable needs of patients’ in providing or arranging access to essential and additional services delivered under the GMS contract.
The guidance goes beyond the requirements on practices set out in the GMS contract, the PMS agreement and regulations. Some practices have been approached by their CCG to question their arrangements.
The BMA GPs committee has been clear with NHS England that it does not agree with the guidance. We have also confirmed it is non-binding for commissioners.
Find out more about your obligations below.
Core hours and service delivery
GMS regulations define:
- core hours as 8am to 6.30pm, Monday to Friday (excluding bank holidays)
- the essential and additional services which practices are required to deliver.
GMS regulations do not require practices to:
- be open at all times during core hours
- deliver all services at all times when they are open.
They do require practices (either themselves or through subcontracting arrangements) to:
- provide services at times that are appropriate to meet the needs of patients
- ensure arrangements are in place for patients to access services throughout core hours in case of emergency (this allows practices to close, for example, to undertake training or staff reviews).
- the GMS regulations allow individual practices to decide which services to provide when, to meet the needs of their patients
- practices should be able to show they have engaged with their PPG (patient participation group) to check the arrangements are meeting their reasonable needs, and are addressing any areas of concern (within the regulations regarding PPGs).
Subcontracting arrangements during core hours
GMS regulations allow a practice to subcontract services, provided that:
- it has taken steps to satisfy itself that it is reasonable to do so
- the sub-contracted provider is qualified
- notice is provided to the commissioner.
There are no requirements that subcontractors must provide specific services for patients beyond meeting the obligations of the GMS contractor.
The practice must be satisfied that subcontracting arrangements are appropriate and can meet the subcontractor's obligations.
Practices must notify the commissioner, who can only object on the grounds that it would put patient safety at serious risk or put the commissioner at risk of material financial loss. The commissioner cannot object based on failure to meet the criteria in the NHS England guidance.
If you are challenged
If the commissioner believes your hours are not meeting the reasonable needs of your patients, they will likely approach the practice to discuss this.
- You should provide information to the commissioner, showing:
- the times of delivering services meet the reasonable needs of patients
- that outside of these hours, there are arrangements so that patients can access services in an emergency
- engagement with your patients (usually via the PPG) around hours.
- If the commissioner serves a breach notice as it believes you are not meeting the reasonable needs of your patients, the onus under the regulations is on the commissioner to evidence that claim as part of the breach notice.
- If your commissioner approaches you regarding the reasonable needs of your patients and produces NHS England guidance as evidence, we advise that you inform the commissioner this guidance is not a contractual requirement.
- We also advise that you contact the BMA general practitioners committee and your LMC.
NHS England have said they will provide over £500 million recurrent funding by 2020/21 to enable CCGs to commission and fund extra capacity across England.