General practitioner (GP) practices are independent contractors to the National Health Service and their contracts require them to provide essential and additional services at such times within core hours, as are appropriate to meet the reasonable needs of patients. Core hours for GP practices contracted under General Medical Services (GMS) contracts are defined as 8:00 – 18:30, Monday – Friday, excluding weekends and bank holidays. Core hours for locally negotiated Personal Medical Services and Alternative Provider Medical Services are set out in their contract but largely mirror GMS opening hours or longer.

It is for each practice to determine any appointments system which they feel best meets the needs of their patients. Also, it is for GP practices to organise the delivery of their services to meet the terms of their contracts and to meet quality and safety standards set by the Care Quality Commission. Contractually, GP practices should report any disruption in the delivery of their services which could compromise their ability to meet the needs of their patients. GP practices may seek support from their local commissioner, including agreement to close the practice list to new patients or temporary suspension of patient registrations. The pressures on general practice are well known and that is why the General Practice Forward View sets out a multi-billion pound plan designed to reduce work load.

Local National Health Service trusts and commissioners have responsibility for ensuring high-quality, safe and financially sustainable services, and are expected to consider a basket of measures to assess whether nursing staffing levels for their organisation are appropriate.

At a national level, in July 2016, the National Quality Board issued updated staffing guidance, ‘Supporting NHS providers to deliver the right staff, with the right skills, in the right place at the right time, to support local decision making’, which advises NHS trusts to consider safe staffing levels in the context of this basket of measures.

NHS Improvement collects monthly data returns on staffing levels, vacancy, fill rates, agency data and also quality metrics such as patient safety thermometer and safety incidents. This data is reviewed monthly by regional NHS Improvement teams to support NHS objectives. There are triggers and criteria in the data sets that flag NHS trusts which have staffing and safety issues and these are placed on higher surveillance, with regular input via NHS Improvement teams, to ensure safety and quality.

The latest statistics for October 2017 show that since May 2010, there are now almost 42,700 more professionally qualified clinical staff (full time equivalent) working in NHS trusts and clinical commissioning groups – this includes over 14,200 (9%) more nurses onwards.