We have agreed in previous years that NHS England’s particular interpretation in this document, of “meeting the reasonable needs“ for the delivery of essential services , based as it is on the outcome of patient focus groups at the instigation of a group of MPs, has no status within the regulations , which explicitly state that the manner of delivery of essential services is as determined by the practice. Birmingham LMC’s view on this mirrors that of the GPC, which has, based on its expert legal advice, publically challenged NHS England’s position.
If a practice serves notice on the CCG that it wishes to sub-contract clinical services then under the regulations the CCG may only object to the arrangements if the sub-contract would put the safety of the contractor’s patients at serious risk, put the Board at risk of material financial loss, or the sub-contractor would be unable to meet the contractor’s obligations under the contract.
A practice that has identified that historical demand for services on these holiday afternoons is extremely low, has taken the steps to notify patients that they will be closing early and provided advice to them in respect of ensuring that repeat prescription requests, routine appointment booking, clinical enquiries etc (in line with guidance that has been issued by both the LMC and CCG) are dealt with in a timely manner prior to closure may then legitimately subcontract to an appropriate provider, eg its OOH provider, on serving notice to the CCG. If services are subcontracted to a specific health care professional (i.e. a named locum) then there is no requirement to serve notice on the CCG. It may also be of course that a practice closes early but has a duty clinician providing urgently-required care.