What you need to know as practice managers

NHSE have released “Our plan for improving access for patients and supporting general practice”, so what do we need to know as practice managers?

This financial year, general practice has provided more appointments than in the equivalent period before the pandemic. There is also an acknowledgement that general practice teams have never been busier, and that GP practices have shouldered the lion’s share of the burden of the COVID vaccination programme alongside their normal workload.

A survey of 850,000 patients recognises that, overall, patients are satisfied with general practice, with being able to make an appointment, and with the appointment times offered.  Additionally, the convenience of remote appointments for many patients is accepted.

The NHSE document notes that there is difficulty reported by some patients in accessing their practice by phone, in attaining face-to-face appointments and associated waiting times. Increased reporting in the media coincides with additional complaints received by Healthwatch and the CQC.

Support for staff, with a zero-tolerance approach to abuse, aggression and violence, is reiterated.

The document recognises that the increase in GP numbers has been slower than the increase in hospital doctors, but also states that the ambition is to deliver 50 million more appointments.

There is agreement that general practice made “an impressive almost overnight adoption of remote consultations and triage-first pathways to ensure care could continue during the first wave of the pandemic”. There is discussion about the benefits of remote consultation, and triage, but the document also emphasises that patients’ input into their consultation method should be sought, and that this should include face-to-face appointments unless there is a good clinical reason to the contrary. Additional change for patients comes in the form of a new and diverse set of HCPs to support the work carried out in general practice.

It is expected that it will be a challenging winter and NHSE, supported by the government, have released this guide to show the steps that will be taken to:

(a) Increase and optimise capacity,
(b) Address variation and encourage good practice, and
(c) Improve communication with the public, including tackling abuse and violence against NHS staff

• • There will be further guidance on IPC from UKHSA and this will be provided on the Agency’s website. You can find the guidance here. Importantly, there is a recommendation to reduce the physical distancing to 1m subject to risk assessments and the appropriate Health Building Note.
  • There will be an additional £250m Winter Access Fund. This fund will cover the five months from November to March and will be used to improve access for patients with urgent care needs, according to patient preference, and to reduce visits to hospital:
    • By increasing appointments, hopefully within the patient’s own GP practice, and utilising additional sessions from existing staff or using the digital locum pool framework to provide locum sessions, reimbursable at maximum rates set out in the existing guidance. The fund can be used in a variety of ways, including employing other physicians such as retired geriatricians who cannot join the GP Performers List.
    • To increase capacity across the urgent care system, some of which may include using primary care hubs – including, for example, respiratory hubs to manage cases of RSV. Additional clinical capacity for NHS111 may be considered where general practice cannot expand.
  • Funding is designed to be used by local commissioners to suit their local needs, not as funding to be used as a “pass-through payment” to practices.
  • The maximum funding available will be based on the CCG primary care weighted capitation formula and plans must be developed and submitted by 28th October; it is expected that planning will involve PCN clinical directors.
  • It is expected that all areas will have developed a digital locum bank by December.
  • Focus is being placed on the existing requirement within systems for an increase in staff for their share of a total of 15,000 additional staff by March 2022.
  • There is a drive towards cloud-based telephony solutions, with a possible national solution as a short-term measure, subject to value-for-money, with a possibility of deployment before the end of the year.
  • Practices are encouraged to sign up for the Community Pharmacist Consultation Service (CPCS) before 1st December 2021, if they haven’t already done so.
  • There is an existing pilot study for the supply of contraceptives in community pharmacies; work will continue to decide how far and how fast the role of pharmacists in the supply of medicine can be expanded to support GPs.
  • Where practices have signed up for the Phase 3 COVID vaccination programme, commissioners must consider alternative arrangements for the delivery of the vaccination programme where access is particularly constrained – for example, where there is low availability of access to face-to-face GP appointments.
  • Planned changes to Fit Notes and the access to Fit Notes embedded within hospital systems will hopefully continue to reduce the burden on GPs.
  • Changes to DVLA systems to allow patients with epilepsy and multiple sclerosis to self-declare may be rolled out with additional conditions along with adding to the list of professionals who can provide necessary information to the DVLA.
  • The amended system for GP appraisals continues in 2021.
  • The standard contract for 2021/22 will place a burden on secondary care providers to reduce avoidable administrative burdens on primary care.
  • QOF arrangements will not be revisited for this year, but new PCN service specification will be rephased from October 2021, to no later than April 2022.
  • The planned transfer of CCG-commissioned extended access to PCNs will now be delayed until October 2022.
  • An assessment of locally commissioned enhanced services should be undertaken to see whether funding could be used instead to support urgent same-day access. Services aimed at reducing avoidable admissions should be maintained.
  • Practices should complete a review of their balance of remote and face-to-face consultations by the end of October.

• RCGP have been asked to update their guidance on the optimal blend of remote and face-to-face consultations by the end of November.

• • NHSE will commission an additional QOF module focused on optimal models of access including triage and appointment type

• By April 2022 patients will automatically receive a message following their appointment asking them to rate their access to care. This will be a real-time measure rolled out nationally and incentivised.

• • As part of PCNs, individual practices will be incentivised under the IIF to improve their rates of satisfaction for 2022/23.
  • NHS Digital is working to provide practice-level activity and waiting-time data. As soon as the data comes on stream, patient reported satisfaction levels will also be published.
  • NHSE and NHS Digital will work together on a simple visual tool to help anyone to understand the aspects of general practice performance.
  • The Access Improvement Programme (AIP), working with 900 practices to improve access, will continue. Starting in October, a new intensive version of the programme will be used in 200 practices facing the greatest challenges with access.
  • All ICSs should look at the following data and intelligence on their individual practices:
    • Any practice with overall appointment numbers lower (excluding COVID-19 vaccinations) than in the equivalent pre-pandemic months
    • The 20% of practices locally with the lowest level of face-to-face GP appointments – as opposed to whole practice, including appointments with other staff
    • The 20% of practices with the most significant level of 111 calls from their patients during GP hours
    • The 20% of practices with the most significant rate of A&E attendances compared to what would be expected
    • The Care Quality Commission (CQC) will provide NHS England and NHS Improvement with data relating to the volume of feedback they have received at a regional and practice level; this includes concerns, complaints, whistleblowing allegations and feedback received through their ‘Give Feedback on Care’ process.
  • Following rapid local consideration, each ICS should finalise an initial list of practices (which is unlikely to be more than 20% of all local practices) where it will be taking immediate further steps to support improved access. The initial list should take account of the need to address healthcare inequalities and be submitted as part of the plan for action described in paragraph 16 for regional assurance by the close of Thursday 28th October.

• The CQC will work with NHSE to support systems in this process and is developing a new inspection methodology focused on access to GP services. Unannounced inspection will take place if appropriate.

• Work on tackling variation must be undertaken by ICSs in order to access funding from the Winter Access Fund and will need to show how funding will be used and the expected benefits as well as demonstrating how the plan will help those practices struggling the most with access. These plans must also look at ways to help that do not include additional funding.
• NHS England will work with the BMA GPC, the RCGP and patient groups such as Healthwatch and National Voices to develop communications tools that can help people understand how they can access the care they need in general practice.
• NHS England will immediately establish a £5m fund to facilitate essential upgrades to practice security measures, distributed via NHS regional teams.
• The Government and NHSE will work with trade unions to develop a campaign around zero-tolerance for abuse to staff.
• The Government is introducing legislation that doubles the maximum sentence for common assault to two years if the victim is an NHS worker.

In short, there is plenty for practice managers, PCN managers and ICSs to be getting on with in the coming weeks and months.  

Certainly, the news that the focus will be ‘access’ will come as no surprise to most of us, but this winter will prove more challenging than ever as patient expectations are raised and we struggle with the normal winter pressures exacerbated by COVID.