As reported by GP Online, overwhelmed GP practices in Kent and Medway can now divert patients and receive extra support through a trial ‘black alert’ scheme
GP leaders have long called for a support system similar to the operational pressures escalation levels (OPEL) system used in hospitals to be established for general practice.
Under the OPEL system, hospitals report the level of pressure they are under on a four-point scale, with set responses triggered to support them when they are facing unsustainable strain.
NHS England confirmed last year that it was working on plans to bring general practice under the umbrella of the OPEL framework – and a manifesto published by the RCGP last October said integrated care boards (ICBs) should be required to set up OPEL-style alert systems for general practice.
GP black alert system
Kent and Medway ICB has drawn up an OPEL framework for general practice in partnership with Kent LMC – and is now seeking practices to sign up to trial it. The system considers both internal pressures such as staff shortages and external factors such as problems with the wider health system that are adding to pressure on general practice.
The Kent system would allow practices to declare themselves at OPEL 4 – the highest alert level, equivalent to a ‘black alert’ – for reasons including having less than 70% of clinical staff available or facing premises problems such as flooding or total loss of power that make delivering care impossible. External factors such as a surge in work diverted to practices from NHS 111 or a sharp rise in care home patients requiring face-to-face assessment could also lead to an OPEL 4 alert.
For a practice at OPEL 4, the ICB would be required to ‘mobilise support from teams within the ICB’, taking steps such as offering additional staff, agreeing plans to cover care homes and housebound patients among other steps. Practices could also be supported to close temporarily, stop taking appointments and divert patients elsewhere.
OPEL 3 can be activated for reasons including a practice operating with clinical staff at less than 80% and unplanned activity at an increased level. Practices at OPEL 3 could be offered additional staff, and the ICB could trigger measures such as asking urgent treatment centres to support same-day access, or community teams to take on additional roles supporting care homes.
Supporting practices
A practice could declare itself at OPEL 2 if, for example, it is busier than usual, with less than 90% of clinical staff available. OPEL 1 is categorised as signifies ‘business as usual’ – with practices ‘able to meet patient flow and anticipated demand within available resources’.
A spokesperson for NHS Kent and Medway said: ‘We are planning on launching a pilot for a primary care alert system soon. This pilot will test a number of potential actions to support practices and enable safe, high-quality patient care to continue during additional periods of pressure.’
The pilot will run alongside the existing GP alert state (GPAS) system that is in use across much of England, with practices in Kent asked to continue to complete GPAS.
An update from Kent LMC said: ‘The ICB has developed, with our support, an OPEL response framework which outlines support that could be offered to practices when a practice self declares amber/red/black state.
‘This guidance outlines criteria that may determine a practice’s red amber green (RAG) state, the triggers, both internal and external, and the response that the system can provide.’
The LMC added that the pilot will not be used as a performance management tool and that practices taking part will have the option to withdraw.
‘We appreciate how pressured practices are and it is not intended that this should add to practice workload but hopefully to provide help,’ said the LMC.
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