BMA advice on declining non-GMS / unfunded work or work inappropriately transferred from secondary care

The clinical and professional responsibility you have for your patients does not mean that you must provide services over and above those for which you are contracted, or that you cannot give reasonable notice to cease doing such additional services.

The BMA has useful advice regarding how to answer responses you encounter when declining non-GMS or unfunded work:

'It's not professional'

What I do outside my contract is a personal choice and plenty of other professionals decline extra work if the remuneration is not appropriate.

'This is a GMC matter'

It is not a matter for the GMC and indeed, threatening referral and using this as a threat for me to work extra in my own time is harassment. I continue to deliver everything expected of me as required under my contract [latest information on the 2025-26 contract available here and GPDF have funded a useful consolidated document “NHS General Medical Services Contracts Regulations Wales Consolidated 2025”] and Good Medical Practice [download here]. Whether or not I undertake additional extra-contractual work is my choice.

'You have a responsibility to the patients'

And I take that responsibility very seriously and will continue to fulfil all aspects of my contract and continue to deliver excellent care. However, I cannot be forced or made to feel guilty about not undertaking extra work in my own time for inadequate rates of pay.

'Your colleagues are doing this work'

Being extra contractual it's a matter for personal choice.

'You are taking money from other staff'

The funding of the health service is a matter of political choice for the government. I am only asking to be paid fairly for work I undertake that is outside of my contract.

'You are taking money from patients'

The government have a responsibility to provide a health service, it is not the responsibility of individuals. Part of that responsibility is to pay staff enough to motivate them. It's a political choice.

'There is a financial crisis'

It's not fair that the public sector is expected to pay for every financial crisis when others in the economy do not. We cannot expect NHS staff to subsidise the service with their own pay.

'It is not in our budget'

It is not my responsibility to ensure that sufficient budget is allocated to adequately pay doctors to provide the service.

Palliative care non-WCCG communication requests

The LMC is aware of a recent communication sent to GP practices from the Palliative Care service regarding proposed changes to communication workflows, including requests for dedicated "monitored" email addresses and direct telephone lines.

It is unfortunate that the LMC was not consulted prior to this request being issued. While we fully understand the shared frustrations regarding communication between primary and secondary care, the requests made by the Palliative Care service are, in our view, unsustainable and unreasonable given the current pressures on general practice.

The request for a "constantly monitored" email address that provides real-time confirmation of receipt and action is not feasible. GP practices are not resourced to provide a live "command" email service, and diverting staff to monitor an inbox for real-time updates would detract from essential clinical and administrative duties.

We would like to remind colleagues and our partners in secondary care that there are already clear, established, and secure methods for communication:

• WCCG (Welsh clinical communications gateway) This remains the primary and appropriate digital route for formal communication.

• GP Bypass Numbers: Most practices already have established bypass lines for professional use to avoid public queues.

The LMC advice to all GPs is to decline the request to provide a bespoke, real-time monitored email address. If you choose to respond to the Palliative Care team, we suggest the following wording:

"While we appreciate the desire for efficient communication, it is not possible for the practice to provide a dedicated email address that is monitored in real-time. Such a request exceeds our current capacity. We kindly ask that you continue to use the established WCCG routes for written communication and the existing GP bypass number for urgent verbal queries."

We are often just as frustrated when trying to contact secondary care clinicians. However, the solution is to optimise the use of existing systems rather than creating new, unresourced administrative burdens for individual practices.

The LMC will be reaching out to the Palliative Care service leads to discuss a more integrated and mutually agreeable approach to communication.

Updated Information for GPs working in Out of Hours regarding General Medical Practice Indemnity (GMPI) cover (January 2026)

OOH Remote Prescribing Risks

Prepared by Dr Nimish Shah January 2026

Overview

The LMC have received reports of increasing pressure on GPs to sign prescriptions for remote clinicians—including non-GP specialists—within the Out of Hours (OOH) service. The feedback the LMC have received suggests that the current "Crown Indemnity" assurance may be creating a false sense of security. While it provides financial cover for the Health Board, it does not mitigate the personal professional risk to a GP's registration when signing for a clinical assessment they did not perform.

This briefing note covers:

• The distinction between Financial Indemnity and Professional Défense

• The specific risks of signing for non-GP specialists (e.g., Paediatricians)

• The contractual obligations and the role of the LNC in negotiating these terms

1. The Core Risk: Responsibility vs. Cover

There is a significant distinction between financial protection and professional protection. It is vital that clinicians understand the limits of Health Board cover:

• Financial Indemnity (Health Board/Crown Indemnity): This covers the financial cost of a clinical negligence claim (payouts to patients). It does not provide personal legal representation.

• Professional Protection (MDOs e.g., MPS, MDU): This provides legal defense for GMC investigations, Coroner’s Inquests, and Disciplinary hearings.

Key takeaway: A GP who signs a prescription based on a remote assessment they did not perform inherits the legal responsibility for that prescription. If the assessment is later found to be flawed, the "signer" remains accountable to the GMC.

2. Specialist-to-GP Prescribing (Paediatrics)

The recent request for GPs and Pharmacists to sign for remote Paediatricians carries a heightened professional risk:

• Scope of Practice: GPs are frequently asked to sign for dosages or medications (e.g., weight-based calculations or off-license uses) that sit outside standard primary care guidelines.

• GMC Guidance: Good practice in prescribing (2021) states that you must only prescribe if you have sufficient knowledge of the patient’s health and are satisfied that the medication is clinically justified.

3. Contractual & Negotiation Routes

Responsibility is often dictated by the "fine print" of employment:

• Individual Contracts: GPs must verify if "remote cross-signing" is a specified duty in their signed OOH contract. If it is a contractual requirement, the GP is obliged to perform it, provided it is clinically safe.

• Local Negotiating Committee (LNC) Role: While the LMC represents the profession broadly, the LNC is the formal body responsible for negotiating terms for those on Health Board contracts. Collective disputes regarding these working conditions should be escalated through the LNC.

4. Recommendations for GPs

• Seek Individual Advice: Every GP should contact their Medical Defence Organisation (MDO) for a written opinion regarding their specific OOH role and the "line of sight" required for safe signing.

• Document Concerns: If signing under protest or due to contractual obligation, ensure the rationale and the remote clinician's details are clearly logged.

• Competence First: If a prescription feels clinically unsafe or is outside your competence, you have a professional right (and duty) to decline and suggest an alternative pathway.

Update 27/1/26

Further to enquiry from SBHB they can confirm that when an OOH service is provided directly by a HB—whether the HB employs staff or engages locums/agency workers—those individuals are fully covered under the longstanding NHS indemnity not GMPI, just as hospital doctors are with no requirement for this work to be recorded in Locum Hub Wales. There is of course the additional requirement for MDU/MPD etc indemnity for professional issues. The same applies to NHS 111 workers.

Do I Need to Register for the All Wales Locum Register?