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Best Laid Plans 2021/22: What happened to Sajid Javid’s £250m Winter Access Fund?

The £250m promised by Sajid Javid was trumpeted by the Government and NHS England. Pulse asks whether general practice ever saw any of this funding

A missed opportunity, completely out of a touch and an offer that ‘merely tinkers around the edges’ were how GP leaders described Sajid Javid’s plan for improving GP access. The release of the document in October 2021 antagonised the profession – and with good reason, being heavy on targets and scrutiny and lacking on support at a time when general practice was deep in crisis.  

The promise of extra funding though – although caveated – at least seemed like some good news. The plan came with a £250m fund attached, which was distributed via commissioners between November and March. NHS England set out that the money should be used to improve access to urgent, same-day primary care by increasing capacity and GP appointment numbers achieved at practice or PCN level or both, and also to increase the resilience of the NHS urgent care system.

Here we look at how the money was spent and whether it helped.

Overall funding

What the plan said

‘For the five months November to March, a new £250m Winter Access Fund will help patients with urgent care needs to get seen when they need to, on the same day, taking account of their preferences, instead of going to hospital.’

What happened

A Pulse analysis of NHS Digital’s Payments to General Practice 2021/22 shows that around £33m was paid direct to GP practices. The responsibility for spending the funding was mainly given to ICBs. It is unclear just how much was spent by ICBs, but you can see where some of them spent it here.

Workforce support

What the plan said

NHS England suggested the money could be used for: more sessions from existing staff, or making full use of the digital locum pool framework, reimbursable at maximum rates set out in the existing guidance; expanding extended hours capacity, including for example any contingency planning for bank holiday working; and extra administrative staff, eg at PCN, federation or practice level, where commissioners agree that is necessary, and agree that the solution planned is the optimal delivery model. The fund could also be used to employ other physicians such as retired geriatricians who are unable to work as GPs because they are not permitted to join the GP Performers List.

What happened 

For an already overstretched workforce, this was a tall order. Northumberland LMC’s former medical secretary Dr Jane Lothian points out: ‘When there is short term funding like this, extra capacity is generally created by salaried GPs and the odd locum taking on extra shifts. There is no magic tree of experienced GPs and nurses. You can’t conjure up tens of GPs in rural Northumberland.’

But at short notice and with mounting winter pressures, booking in extra sessions was one route that practices opted for. In Derby, for example, LMC treasurer Dr Peter Holden says his practice used locums to provide ‘straightforward, extra appointments on weekdays’. But he adds that this had a knock-on effect on receptionists and admin staff, who had to ‘work a lot harder’. And in South Staffordshire LMC medical secretary Dr Tilo Scheel says practices spent the money on locum cover to provide extra appointments which were ‘largely face-to-face’, which did support GPs. 

There were also cost challenges of securing locum cover. GP partner and Kent LMC representative Dr Zishan Syed tells Pulse: ‘Money was used for locums, but local rates were so high they were of limited use to cover.  I believe at the time rates were advised not to exceed £200 per session or half day. Locums were charging much more than that!’  

For some areas – including some of the most GP deprived in the country – locum cover was almost completely out of the question regardless of whether there was money available. Doing so would have meant pulling a finite resource of locums away from their usual duties of covering sickness and holiday in practices, or long-term vacancies, essentially therefore leaving gaps elsewhere. 

This was the case in Lancashire and Cumbria, where LMC chief executive Peter Higgins says the ICB was asked to instead pursue initiatives that did not place any extra burden on GPs, or require significant numbers of extra GP appointments. This was achieved ‘by and large’ by focusing the money on other staff groups and schemes, he says.   

‘Our files show a variety of schemes were put forward. Some were at system level to improve communications, workforce planning and intelligence gathering. Other examples included training of Care Navigators, and a detailed review of what goes on in a practice, to examine delays and log jams in connection with the interface with secondary and community services.

‘At place level, schemes were approved to develop locum banks and back-office functions, and to develop an acute visiting service. Some increases were agreed where there was capacity in walk-in centres and hubs to see more patients.’

External urgent services to support general practice

What the plan said

Another stipulation for how the fund should be used was to expand same-day urgent care capacity through other services in any primary and community settings. 

The plan said: ‘UTC capacity could be expanded as an alternative to patients’ own general practice service. Systems may wish to use primary care hubs including respiratory hubs (to manage increased cases of RSV, for example), or 111 Clinical Assessment Services (CAS) capacity where general practice is unable to expand, beyond the significant further expansion of 111 already planned.’

It also said practices should make full use of the Community Pharmacist Consultation Service.

What happened 

Examples provided by ICBs of initiatives the money was spent on included community pharmacy schemes for vulnerable people who had not been vaccinated against Covid-19 and those most at risk of hospital admissions with respiratory and cardiac conditions, a care home advice line for GPs open on weekends to mitigate against avoidable hospital admissions, acute visiting services, and a communications initiative with local people explaining the range of professionals now working in general practice and other ways patients can access care.

In Coventry and Warwickshire, LMC executive officer Maggie Edwards tells Pulse that some money was spent on a respiratory monitoring service, which evolved from Covid, whereby patients with breathing difficulties received daily phone calls and their observations were sent in and monitored. 

‘There was also the provision of a surge facility for practices, when they struggled with sudden sickness, such as a particular bug in the neighbourhood. These were delivered virtually by the GP federations… I suspect that additional face-to-face appointments were offered too,’ she says.

‘This funding did offer some support to practices. It’s the same old story – more would have been welcome. But the nature of the beast is that this kind of funding is not recurrent. [Although] to be fair, services such as the surge facility have been continued using other pots of money.’ 

Telephones upgrade

What the plan said 

‘NHS England will enable and drive full adoption of cloud-based telephony across all practices, as rapidly as possible. This could include – subject to value for money – a short-term national solution available for all practices to deploy by the end of the year. This would precede a longer-term supplier framework, to support local deployment of cloud-based products as existing local contracts expire.’

What happened

NHS England told Pulse that additional telephone capacity was offered to all practices last winter as part of the fund. This was via a MS Teams solution, which enabled practices to make outgoing calls using the internet, freeing up existing phone lines for incoming calls. 

A total of 2,420 practices, covering 24 million patients, that didn’t already have cloud-based telephony took it up by the end of February 2022, which was the last period audited, NHSE said. 

The contract this week also laid out plans for all practices to move to a cloud-based telephony system by 2025.

Guidance on provision of face-to-face appointments

What the plan said

‘The Royal College of GPs has a vital role in promoting excellence in primary healthcare and advocating professional standards. To assist practices in working through what is the new optimal blend of remote and face to face triage and care, NHS England and DHSC have asked RCGP to consider providing a further update to its guidance to practices by the end of November, including their advice on how practices can ensure they are providing the appropriate proportion of in-person GP appointments for their registered population, that is both clinically warranted and takes account of patient preferences.’

What happened

In November 2021 the RCGP told Pulse that it had agreed to review NHS England’s feedback on its resources around delivering remote care but was still awaiting the said feedback. It added that it was never NHSE’s intention that the college’s position statement – published earlier in the year – should be reviewed, and said remote consulting should be an option but not the ‘automatic default’. 

The RCGP has since told Pulse that no further update to the guidance was made. It said that it was decided the existing guidance was adequate, but ‘as with all college guidance it is regularly reviewed to ensure it is still relevant’. 

Research into face-to-face provision

What the plan said 

‘NHSE will now also commission an additional QOF improvement module, focused on optimal models of access including triage and appointment type. Additionally, NHSE England will work with research partners such as NIHR with the aim of securing a “big data” analysis of the impacts of remote versus face-to-face consultations and understanding the role of continuity of care at the core of the GP-patient relationship.’

What happened 

The QOF improvement module was introduced for 2022/23 and incentivises practices to make quality improvements that optimise patient access. 

A ‘big data’ analysis on the impacts of remote versus face-to-face consultations, however, has not materialised. Pulse asked NIHR in November 2021 whether it had been commissioned to do such a piece of research, but the organisation had no knowledge of it. NHS England did also not confirm what stage this analysis was at, but told Pulse it ‘works closely with research partners and funders to gain better understanding of how primary care has changed and continues to change, including, for example, the Health Foundation’s Improvement Analytics Unit’. 

Practice security

What the plan said 

‘NHS England will immediately establish a £5m fund to facilitate essential upgrades to practice security measures, distributed via NHS regional teams.’

What happened

Speaking on BBC Breakfast during the week is plan was launched, Sajid Javid suggested this fund could be spent on CCTV, panic buttons or ‘other kinds of support’ for practices. 

A number of LMC leads Pulse spoke to said they had never heard of the security fund. 

Abuse of GP staff

What the plan said

‘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.’ 

What happened

NHS England told Pulse it developed national campaign materials to promote respect for all primary care staff. The materials for general practices included posters and social media assets and have been downloaded 1,500 times since their publication in October 2021.

It added that NHSE is continuing to work with partner organisations to develop practical support for primary care employers and employees and with practices and PCNs to mitigate against the risk of violence and abuse. 

The evidence suggests that the abuse problem in general practice is only getting worse though, with more unprovoked attacks reported over the winter. This included physical assaults on practice staff in Essex and Surrey and a patient trashing a practice waiting room in Derby. Meanwhile, three-quarters (74%) of 1,000 GPs responding to a recent Pulse survey said they and their staff experience verbal abuse on a weekly basis, including 40% who receive it daily.