- Regional Directors of Primary Care and Public Health
- Integrated Care Board Chief Executives and Chairs
- Primary Care Network Clinical Directors
- All GP, Dental, Community Pharmacy and Optical providers
- All Urgent and Emergency Care Providers
12 September 2022.
Funeral plans and arrangements for primary care services.
I am writing following the death of Her Majesty Queen Elizabeth II and the activation of arrangements relating to her lying in state and subsequent funeral.
The government has confirmed that Monday 19 September will be a Bank Holiday. We have agreed with government that the NHS will be responsible for determining the patient services that should be maintained on this day, including primary care.
As the commissioner of primary care services, NHS England and integrated care boards (ICBs) have the responsibility to ensure patients can access the primary care services they need. However, primary care professionals and their teams will want to pay their respects on this day wherever possible and contractually may be supported to do so with the declaration of the bank holiday.
As a result, I am writing to set out expectations for ensuring there is ongoing access available to NHS primary care services as follows:
- COVID-19 vaccination services. Given the importance of delivering the COVID-19 autumn booster programme, we would ask that scheduled care home visits (which are a high priority for the programme) are maintained and delivered as planned. We strongly encourage any clinics scheduled on that day to be maintained particularly where there is a high population need. Providers should discuss with their local commissioner any need to flex or condense hours to support providers.
- Cover for core GP services. GP practices will be contractually able to close on this day for their core services as it is a confirmed bank holiday. ICBs will need to urgently work to ensure sufficient out-of-hours (integrated urgent care) services capacity is in place during what would have been core hours to meet patient’s urgent primary medical care needs.
Extended hours access. Primary care networks (PCNs) that had planned to provide Extended Hours on this day may wish to continue to offer these hours or cancel as per para 8.1.7 of the Network contract DES specification. The PCN must make up the cancelled time by offering additional appointments within a two-week period unless otherwise agreed by the commissioner. The PCN must ensure that all patients are notified of any cancellations and rescheduling of appointments.
GP practices will also wish to consider rescheduling pre-booked appointments and enabling patients to receive prescriptions, especially repeat medicines, in advance of the bank holiday. Likewise, it will be important for practices to signpost to other local primary care services when the practice is closed.
- Dental and community pharmacy. NHS England regional teams (and delegated ICBs where applicable) will need to work with dental and community pharmacy providers to confirm available services on the bank holiday, ensuring patients can continue to access urgent dental care and have continuing convenient access to medicines.
- Optometry services. Optometry practices may choose to open on Bank Holidays and should notify their NHS England regional teams (or delegated ICB where applicable) should their opening hours differ to their contractual obligations.
In planning for this day, primary care commissioners and providers should note the likelihood of closures amongst schools and childcare settings, impacting childcare arrangements. Supermarkets/large stores may also close or operate reduced opening hours impacting in-store pharmacy opening.
To support commissioners and providers in their planning, the annex to this letter sets out the contractual positions for primary care services on a bank holiday.
Sharing information with patients:
Please ensure patients are kept fully informed of the arrangements made by utilising available patient communications, websites and on-site notices. It is also important to ensure the Directory of Services is updated accordingly for the bank holiday.
For patients with planned appointments that are affected by the bank holiday, please ensure they are informed in advance of any changes by utilising direct patient communications. Where planned appointments are going ahead it is important this is also confirmed with patients.
We hope that this communication provides clarity in relation to commissioner expectations of access to primary care services over the period.
If there are any questions, please contact your regional NHS England or delegated ICB contracting team as appropriate.
Dr Ursula Montgomery, Director of Primary Care, NHS England
Bank holidays and primary care services
COVID-19 vaccination services in primary care
Enhanced Service Specifications for the COVID-19 vaccination programme applying to both general practice and community pharmacy are clear all sites/services must have the ability to deliver during the hours of 8am to 8pm, 7 days per week and including on bank holidays where needed. Actual delivery hours will have been agreed for the day that is now declared a bank holiday and should therefore proceed given the importance on delivering of the Covid-19 autumn booster programme.
Core general practice services
GP services must operate during core hours which are 08:00 to 18:30 Monday to Friday excluding weekends and bank holidays to meet the reasonable needs of their patients.
GP services outside core hours: Extended hours and extended access services
Primary Care Networks that had planned to provide Extended Hours on the day that is now declared a bank holiday under the Network Contract Directed Enhanced Service (DES) (and which have not otherwise been repurposed for Covid-19 vaccination services) may wish to move these hours to either:
- support access to urgent appointments during core hours on that day; or
- another day to help support deferred patient demand during extended hours.
The DES is clear any cancellation of extended hours access appointments, including arrangements for re-provision should be re-offered within a two-week period around the original appointments and all patients within the PCN must be notified.
ICB commissioned extended access services covering weekday evenings (from 6.30pm) and weekends and bank holiday provide access to routine and urgent appointments with primary care professionals (i.e. GPs and nurses). ICBs must ensure access is available during peak times of demand. However, in view of short notice bank holiday it is recognised it will be difficult for providers to flex additional “step-up” capacity or necessarily anticipate demand. ICBs will want to work with their extended access providers to ensure available capacity is optimised to best support urgent clinical needs on the bank holiday.
GP out of hours and integrated urgent care
These are the urgent primary medical care services provided when GP practices are typically closed, delivered during the out of hours period 6.30 pm to 8.00 am on weekdays, weekends and bank holidays.
Like extended access services, ICBs will need to work with their providers to ensure available capacity is optimised.
General and personal dental services
General and Personal Dental Service contracts define “working day” as any day apart from Saturday, Sunday, Christmas Day, Good Friday, or a bank holiday.
As urgent dental care services are commissioned outside of normal working days dental providers will need to ensure they maintain sufficient access on a bank holiday to meet any urgent dental needs i.e. those requiring immediate attention in order to minimise the risk of serious medical complications or prevent long-term dental complication.
Community pharmacies must open for their core contractual hours (40 or 100 hours) and any supplementary hours commissioned unless these fall on a public or bank holiday.
NHS England or delegated ICB where appropriate will confirm with community pharmacies which services will open via mutual agreement.