As practices are increasingly under pressure from workload demands, they are contacting LMCs with queries relating to whether or not the provision of a service falls within the definition of an essential service (‘core’). As this relates to the national contract, these concerns have been escalated to GPC England who have subsequently sought legal advice on whether ICBs can determine what GPs should be delivering as part of essential services. The legal advice is clear that, within certain limitations, it is up to GP practices to decide which services they will provide within the practice as opposed to via referral and it is not within ICB’s powers to make such determinations.
Full details of the BMA’s guidance and legal advice are available here, and should be read in conjunction with the latest available version of the National Health Service (General Medical Services Contracts) Regulations 2015.
Summary
Regulation 17(4) defines ‘essential services’ as ‘services required for the management of a contractors’ registered patients and temporary residents who are ‘ill’, ‘delivered in the manner determined by the contractor’s practice in discussion with the patient’.
Regulation 17 also specifies that ‘essential services include the ‘provision of appropriate ongoing treatment and care’ including ‘advice’ and ‘referral for services’. However, Regulation 17(6A) specifies five categories of service that must be delivered ‘in house’ and not via onward referral. These are:
- cervical screening services,
- child health surveillance services,
- contraceptive services,
- maternity medical services, and,
- vaccine and immunisation services.
Action practices can take
Where practices are being pressured by ICBs to provide certain services in house which practices reasonably determine that they can refer onwards to other providers, they are advised to contact their local LMC to highlight these concerns. They are also invited to send the BMA’s template letter to their ICB.