Do practices need to have their online consulting tool available for patients to use throughout core hours?
Practices need to consider the PCN DES specification, GMS contract and NHS England guidance in considering this question.
The local capacity and access improvement payment in the 2024/25 PCN DES specification relates to three components of Modern General Practice Access as described in the Delivery Plan for Recovering Access to Primary Care, these are:
- Better digital telephony
- Simpler online requests
- Faster care navigation, assessment, and response.
As per the specification about CAIP Payments. When all the assessment criteria relating to an improvement have been met across all Core Network Practices, the PCN can notify the commissioner through submission of the CAIP payment form and thereby request payment. The total amount that the PCN could be paid if all three improvements are achieved, equates to £1.392 multiplied by the PCN’s Adjusted Population and that the CAIP for each improvement equates to a third of this amount, which breaks down into.
- Better Digital Telephony – £0.464
- Simpler Online Requests – £0.464
- Faster care navigation, assessment, and response – £0.464
Meeting the requirements for simpler online requests, places a difficulty for practices in that to qualify for this payment the practice needs their online consultation platform available for patients to make administrative and clinical requests at least during core hours. This may not be safe for a practice to do and impacts on their ability to adopt safe working practice as outlined by the BMA.
A practice may then decide not to partake in this part of the DES and forego the £0.464 per PCN adjusted patient.
From 2019 the GMS contract does state that practices are required to offer online consultations that can be used by patients, carers and by practice staff on a patient’s behalf, to gather submitted structured information and to support triage, enabling the practice to allocate patients to the right service for their needs. However, the current GMS contract regulations do not state that online consultations need to be available to the patient throughout core hours.
NHS England nNew digital and online services requirements: guidance for GP practices states that as practices must ‘offer and promote’ the online consultation tool to patients during core hours, patients should therefore be able to conveniently find and use the tool and it should be available to them to use. This is NHS England guidance, and the current GMS contract does not state that this is throughout core hours.
As such Londonwide LMCs’ view is that having the online consultation tool available throughout core hours is not a contractual requirement; but if practices do not offer this service, they will not be able to claim this element of the CAIP payment.
Communicating with patients
If a practice has decided not to have the online consultation tool available throughout core hours, this should be clearly communicated with patients. There are several examples of good practice on GP websites, and these normally include a clear, informative message when the patient clicks on the link for the online consulting tool. The actual message will be dependent on how the practice is utilising their online consulting tool.
- Example text for a practice using online consulting for all consultation requests:
“eConsult online consultations are only accepted Monday to Friday, 8am-6.30pm but may close earlier if the practice reaches capacity for the day.
You can submit a request again from 8am tomorrow.
If you need help, call the practice. Outside of practice hours, call 111. In emergencies, call 999 or go to A&E.”
- Example text for a practice using online consulting for non-urgent consultation requests only:
“This request will be read by a member of the team within two working days. Please do not put clinical requests in Admin queries, please use ‘I want help for a medical issue’.
If you need more urgent help, call your GP. If your GP practice is closed, visit NHS 111 online or call 111. In an emergency call 999.”
Then under the option “I want help for a medical issue” the patient must confirm it is not an emergency by checking a list of symptoms, displayed in a clear text box, that advises the person to call 999 prior to submitting their request if they have any of the listed symptoms.
If a practice does close their online consultation tool during core hours, they should also update their telephone message clearly informing the patients that they either only have emergency appointments or are at capacity for the day, and that due to this the online consultation tool is currently not available.
Further information