The row between practices and NHS England escalated today as new instructions were issued on increasing use of the controversial e-consult systems.

It followed a vote of no confidence in NHS England delivered yesterday by the British Medical Association’s GP committee, breaking current talks on contracts and other matters. The dispute was triggered by last week’s letter from director of primary care Dr Nikki Kanani, apparently ordering practices to resume booking face to face appointments. GPs and practice staff were angered by allegations in national newspapers that they had been avoiding patients and by the implication that face to face appointments have not been taking place.

More than a thousand people have now signed a petition calling for Dr Kanani to resign, organised by the group GP Survival. The Royal College of GPs, meanwhile, distanced itself from last week’s letter, which had followed a college report arguing that the system of “total triage” was no longer needed.

Instead, NHS England has issued a further directive calling on practices to make full use of the controversial e-consult system, the Health Service Journal reported. Some practices have limited the service at weekends after being deluged with a range of inquiries on Monday mornings. Practices have complained that the service has been used to send thousands of trivial inquiries to GPs.

BMA GP committee chair Dr Richard Vautrey said: “Last week’s woefully badly judged letter from NHS England was the final straw for many hard-working GPs, who have gone above and beyond over the last year. They have continued to provide care for their patients under the most difficult circumstances, only for their efforts to be undermined and instead issued with a public rebuke which also inferred that surgeries had been closed to face-to-face appointments. This could not be farther from the truth; almost 164 million face-to-face patient appointments were undertaken between March 2020 and March 2021. And for NHS England to glibly announce that practices should now see even more patients face-to-face without providing anything in the way of extra support or guidance on how to continue to protect patients and staff from the risk of a potentially lethal virus, is at best nonsense, but at worst extremely dangerous.

“The profession has had enough of ill-conceived top-down directives that fail to consider the day-to-day reality in scores of doctors’ surgeries. We know that some patients are frustrated at long waits for treatment or being unable to get a face-to-face appointment when they’d prefer one. GPs everywhere share that frustration. This is not the fault of individual practices or doctors, and instead of issuing tone deaf letters, in what seems to be a reaction to media coverage, rather than based on the needs of the profession, NHS England and the Government must shoulder the responsibility and face the reality of years of failing to value, support and invest in general practice to ensure that GPs and their teams have the capacity to meet the growing needs of the population.”

The latest NHS England guidance, issued last night about e-consult and obtained by the Health Service Journal, says: “Patients should be able to make requests via an online system at any time. Any time patient access to online tools does not mean that practices are expected to respond to these requests outside of core hours and switching off online consultation systems out of hours is likely to be less convenient for patients and reduce patient satisfaction.

Referring to the switching off of e-consult, it says: “For this reason practices should inform their CCG before proceeding and explore whether additional support may be available.”

NHS England was contacted for comment on the developments.