England General practitioner General Practitioners Committee

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NHS England standard hospital contract guidance

As outlined in the GP Forward View, the new NHS standard contract for secondary care trusts came into force on 1 April 2016. The NHS standard contract for secondary care trusts has placed new requirements on hospitals to reduce inappropriate bureaucratic workload shift onto GP practices. Many of those changes to the standard contract have been brought about as a result of ongoing negotiations between GPC and NHS England to get them to understand how important it is that the bureaucratic burden that all GPs are under is reduced.

Despite these contract changes, it is clear that most CCGs and hospital providers have not implemented these changes, with practices continuing to be burdened with inappropriate demands. At the specific request of GPC, a letter reiterating these new requirements was sent on 28 July to CCG Accountable Officers, and Chief Executives of NHS trusts from Matthew Swindells, National Director: Operations and Information at NHS England, and Robert Alexander, Deputy Chief Executive of NHS Improvement.

We have created templates to provide practices and LMCs with resources to hold both CCGs and hospital trusts to account to implement these contractual changes, which can liberate an estimated 15 million wasted GP appointments annually, as well as reduce significant bureaucracy and administrative workload for practice staff.

 

  • Practice checklist - what to do next

    1. Develop a practice policy on how to push back on inappropriate hospital requests that breach the standard contract. Perhaps use your next practice meeting to agree this.
    2. Ensure all GPs in the practice are made aware of these new standards, and use our templates (or any of your own), on each occasion that a hospital has failed to meet these new standards. Embed the template into your clinical system for automated use (you could request your CCG IT lead to support implementation).
    3. Ensure that the breach is notified to the CCG using our CCG template.
    4. Keep a practice record of all breaches, and the nature of the breach. Feedback the numbers and nature of any breaches to your LMC on at least a monthly basis.

     

  • Letter template packs

    Download a pack of letter templates (PDF or Word) to help you manage inappropriate workload.

    NHS standard contract letter templates pack - England (PDF)

    NHS standard contract letter templates pack - England (Word)

     

  • Template letters by topic for practices

    1. Template response for missed appointment

    2. Template response for delayed discharge summaries

    3. Template response for delayed clinic letters

    4. Template response for onward referral

    5. Template response for provision of medication following discharge

    6. Template response for follow-up of results and investigations

    7. Template letter from practices to CCG, informing them of the breach by the provider

    Practices should also keep a record of numbers and categories of breaches, and ideally provide this information to the LMC, to strengthen local negotiations.

    While this will require some administrative work from practice, this should be less than the current bureaucracy of acting on inappropriate hospital requests, and should be seen as a mechanism to change hospital behaviour to free up time and workload for practices.

    CCGs could also provide assistance to practices to load the templates onto their clinical computer systems, or resource practices for this ongoing contract monitoring via a local scheme, as part of their commissioning obligation to ensure delivery of these new requirements.

     

  • Template letters by topic for LMCs

    We have produced template letters for LMCs (which can be locally adapted) to send to CCGs and hospital Trusts to hold them to account to meet these requirements:

    • Template letter from LMC to Trusts asking them for a report on what arrangements have been made to implement the changes set out in the new standard hospital contract.

    • Template letter from LMC to CCGs reminding them of the changes to the standard hospital contract and asking them what measures they have put in place to ensure that Trusts implement these, and to hold CCGs to account for their commissioning responsibilities.

    We would also suggest that LMCs should request for this to form a rolling agenda item at LMC/CCG liaison meetings, with feedback of hospital performance on these new contractual requirements.

    LMCs should feedback examples of significant breaches to their link LMC reference group lead, or to their regional GPC representative, so that we can take this up directly with NHS England.

    Implementing the above will be a small, but significant step in reducing inappropriate and unresourced workload for GP practices, as part of a wider programme of action that GPC will be promoting to empower practices to push back on inappropriate demands.

     

  • Template letters for SystmOne

    Option 1 - Join organisation group

    This option is easier to setup and the templates will be automatically updated in the future if needed.

    1. Go to Setup > Users & Policy > Organisation Groups > Wiltshire > BMA NHS Contract letters (Ardens)
    2. Click “Join group” and then turn SystmOne off and back on again
    3. To access the letters, go in to letters as normal and find the contract letters under Ardens > BMA letters

    Option 2 - Download and import

    1. Right click and choose 'save link as' to save this file to your computer
    2. On SystmOne go to Setup > Referrals & Letters > New word letter templates
    3. Click import templates and select the file that you have downloaded

    To access the templates, you will find the templates amongst all of your other referral and letter templates.

    We would like to thank the team at Arden’s for creating these templates.

     

  • Template letters for Emis Web

    1. Download the ZIP file and copy the files within it to a folder on your computer.
    2. Open EMIS Web and select Configuration -> Template Manager.
    3. Select the "Document Templates" tab and Select "Add -> Folder" and call it "BMA".
    4. Select "Import" and import the Word documents.

    We would like to thank QMasters Medical Informatics for creating these templates.

     

  • Template letters for Vision

    Download the templates onto your computer. Please save these to a sub-folder within the 'Template' folder.

    We would like to thank Dr Michael McKenna and NIGPC for creating these templates.

     

  • Get the support you need

    We have written separately to LMCs with resources to hold both CCGs and hospital trusts to account to implement these contractual changes, which can liberate an estimated 15 million wasted GP appointments annually, as well as reduce significant bureaucracy and administrative workload for practice staff to ensure patient safety and the well-being of GPs and their staff.

    Find your LMC

    See what GPC are working on

     

  • Related resources

    Letter from NHS England to trusts, gateway reference 05593

    NHS Standard Contract 2016/17 Technical guidance