NHS England has announced £250m winter funding for GP practices. The funding is ostensibly to support practices to deliver at least pre-pandemic appointment levels but comes with strings attached. Here Pulse Intelligence outlines the key points.
NHS England said the winter funding of £250m for general practice is supposed to ‘increase the proportion of appointments delivered face to face’.
In a statement, it said the money can be used by practices to fund ‘locums and support from other health professionals’.
Practices that ‘do not provide appropriate levels of face-to-face care’ will not be given funding, the statement said, but will be ‘offered support to improve’.
The statement outlined that:
The package has come after intense lobbying from sections of the media for practices to see patients face to face.
The details are published in NHS England’s document ‘Our plan for improving access for patients and supporting general practice’. Below is a summary of the key points.
As an extension to the £120m Covid funding made available to general practice between April and September 2021, a further £10m is being made available in the same way for October 2021.
For the five months from November to March, a new £250m Winter Access Fund is to be distributed in return for ensuring patients with urgent care needs are seen the same day.
The funding is to be used for:
i) increasing capacity and GP appointment numbers achieved at practice or PCN level, or in combination – by: funding more sessions from existing staff, or use of the digital locum pool; expanding extended hours capacity; taking on more admin staff; employing other physicians ‘such as retired geriatricians’.
ii) Expanding same day urgent care capacity in other primary care and community settings – by: increasing urgent treatment centre capacity; use of respiratory hubs (to manage increased RSV cases, for example); further expansion of 111 Clinical Assessment Services, where general practice is unable to expand.
It is up to local commissioners to determine how the funding is used; ICSs have to submit a plan by Thursday 28 October and PCN clinical directors must be involved in developing the plan. Some funding will be released early in November based on indicative allocations but may be clawed back subject to performance.
Local systems have to demonstrate they are working on reducing variations in access in order to secure funding from the Winter Access Fund.
Each draft plan submitted must include two parts:
National funding will not be released to any ICS unless its plan adequately tackles both aspects.
Targeted action on struggling practices
All ICSs are expected to identify the 20% of lowest performing practices, in terms of face-to-face appointment levels, calls to 111 during GP hours, most significant A&E attendance rates relative to expected levels, and lower than pre-pandemic appointment levels.
A ‘wide variety of actions’ may be taken with these practices, such as to ‘increase resilience’ or make smaller practices partner with other practices, federations or PCNs.
Practices that do not engage could face contractual action from the CQC or ICS.
Practices expected to increase overall appointment numbers
Those that do not reach pre-pandemic appointment levels by November will not receive any winter funds, but should access further support.
Local systems need to increase overall appointment volumes in general practice and ensure appointment levels reflect the full deployment of ARRS staff.
They also need to increase the proportion of face-to-face appointments, in particular at those practices where levels are ‘a cause for clinical concern’. The document notes that most practices are still working out the optimal balance of remote and face-to-face appointments, but that a minority of practices are offering suboptimal access, with over 15% offering less than 20% of appointments face to face.
And they need to minimise 111 calls during GP hours, ensure fuller use of 111 routing calls to GP practices, and reduce avoidable A&E attendance that could otherwise be seen in general practice.
All practices must sign up and ‘make full use of referrals’ to the GP Community Pharmacist Consultation Service for minor illnesses by December (GP CPCS). Practices won’t be able to access the winter funding if they don’t sign up.
Covid vaccination programme may be taken off practices
If access at a practice delivering Covid vaccinations is a problem, for example if face to face appointment levels are inappropriately low, commissioners may take the enhanced service off them and find a different route to offer the service – for example, through community pharmacy.
Intensive support for >200 practices with worst access
An intensive Access Improvement Programme (delivered by the Time for Care team) will support more than 200 practices with greatest access challenges to reduce waits and increase the number of appointments offered each day, including through face-to-face care.
On-site support will be provided by primary care improvement experts, with a tailored practice improvement plan to make appropriate use of digital tools, ensuring sufficient face to face care, and best use of the multidisciplinary team.
New QOF improvement model to reward F2F
NHS England is to commission an additional QOF improvement module, ‘focused on optimal models of access including triage and appointment type’.
NHS England will also work with research partners such as National Institute of Health Services Research to analyse the impact of remote versus face-to-face consultations and ‘understand the role of continuity of care at the core of the GP-patient relationship’.
UK Health Security Agency advises reduced social distancing in practices
In conjunction with the new package, the UK Health Security Agency (UKHSA) has recommended practices should reduce social distancing from 2 metres to 1 metre to help improve access to GPs.
The change is part of a UKHSA review of infection prevention and control guidance.
In a statement the UKHSA said: ‘Physical distancing can be reduced from 2 metres to 1 metre in primary care and general practice with appropriate mitigations, such as the continued use of face coverings or masks.
‘This builds on the recommendation from UKHSA to align physical distancing guidance in acute care settings that was published in September 2021 with updated World Health Organization (WHO) advice.’
It adds however that practices will need to do local risk assessments to identify where physical distancing can be safely reduced, taking into account factors such as access, configuration of the premises and ventilation.
Move to cloud-based telephony
The document notes that around a quarter of practices have already moved to cloud-based telephony, which supports more phone lines for inbound and outbound calls, and automated queuing. Cloud-based systems can also provide data about patient demand to help plan administrative support for call-handling.
NHS England pledges it will ‘enable and drive full adoption of cloud-based telephony across all practices, as rapidly as possible’.
This may include a short-term national scheme available for all practices to deploy by the end of the year.
Patients will receive texts as they finish their consultation
A new real-time measure of patient reported satisfaction will be ‘incentivised as early as April 2022’. Patients will automatically receive a message following their appointment and asked a series of questions about how they rate their access to care.
IIF to incentivise patient satisfaction
As part of plans for PCNs, individual practices will be incentivised under the Investment and Impact Fund (IIF) in 2022/23 to improve patient satisfaction rates. The scale of the incentives will be increased ‘significantly’ in 2023/24 ‘within the planned GP contract envelope’.
NHS Digital to publish practice waiting time and patient satisfaction data
Practices are expected to capture data on activity, capacity and waiting times, with new GP appointment categories being introduced since March this year.
NHS Digital is now working to publish activity and waiting time data at individual practice level as soon as possible. This will include the proportions of appointment by different professions and appointment type. As the new data comes on stream, patient reported satisfaction levels will also be published.
In addition to the above measures that practices will have to comply with under the scheme, NHS England has promised to continue work to reduce administrative burden for practices.
Simplified appraisals process
Changes to annual GP appraisals brought in in October 2020 with simplified information requirements to free up GP and GP appraiser time are continuing.
Electronic fit notes in hospitals
In addition to plans set out in July 2021 to deliver digital fit notes from April 2022 latest, and changes in regulations to allow a wide range of professionals to sign them, electronic fit notes will also be embedded in hospital systems from spring 2022 and hospital doctors will be encouraged to issue fit notes to patients to further reduce burden on GPs.
DVLA licence support
Changes to DVLA licence renewal, allowing patients with epilepsy and multiple sclerosis to self-declare when their condition is stable, will be extended to other conditions and a wider range of medical professionals should be able to provide DVLA with information.
Transfer of data from secondary care
Secondary care providers are already meant to be cutting avoidable administrative burden falling to GPs. From this year a new set of ‘information standards notices’ are to be used to improve the way data are transferred from secondary to primary care, removing the need for email attachments or paper letters.
NHS England has also ‘emphasised that local system plans should hold providers to account’ for stopping redirection of activity to general practice where this could reasonably be arranged directly – such as phlebotomy, prescribing and organising investigations.
No plans to protect QOF income
The document notes the further delay to introducing certain PCN service specifications to April 2022 (aside from hypertension case finding, and tackling health inequalities work).
However, it says that because of a reduction in QOF performance during 2020/21 ‘we are not intending to reopen previously agreed QOF arrangements and repurpose QOF funding to improve access’.
CCG commissioned extended access services – transfer to PCNs delayed
The planned transfer of current CCG-commissioned extended access services to PCNs (originally due to happen from April 2021 and earlier this year deferred to April 2022) will now be postponed until October 2022. This will defer the preparatory work PCNs will need to do before the transfer and therefore prevent diversion of resource away from clinical capacity over the upcoming winter period.
This means the transfer of funding and rollout of national service requirements will happen in October 2022.
The package also pledges support to reduce abuse of staff, which has been intensifying in general practices in recent months.
NHS England will immediately establish a £5m fund to facilitate essential upgrades to practice security measures, distributed via NHS regional teams.
Campaign launch to prevent abuse
The Government and NHS England will work with the trade unions and the Academy of Medical Royal Colleges to launch a zero-tolerance campaign on abuse of NHS staff.
Increased penalties for offenders
The document notes that government is now legislating for the maximum prison sentence for common assault to be doubled to two years if the victim is an NHS worker, through the Police, Crime, Sentencing and Courts Bill 2021.
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