Exclusive Integrated care boards (ICBs) are putting in some special measures to help GPs cope with extreme winter pressures, but are facing resistance from NHS England, Pulse has learned.
LMCs have told Pulse that ICBs cannot go as far as they would like because of resistance from NHS England to suspending QOF.
NHS England has also blocked a plan to suspend QOF wholesale across Devon, which had been signed off by the local ICB before Christmas, Pulse has been told.
One letter sent to practices and PCNs from Derby and Derbyshire ICB before Christmas stated that national or local changes to QOF were not possible but they would stand by GPs to ensure no practice lost out.
‘We understand specifically the impact that managing “above plan” acute demand has on QOF and whilst the QOF is unable to be stood down nationally or amended locally, the ICB will stand behind our practices and work with NHS England to ensure that no practices are penalised financially where demonstrable changes in the balance of practice related activity have been situationally required to occur,’ the letter said.
The same applied to the PCN Investment and Impact Fund which would help practices support the system and free up ARRS staff to help manage pressures, the ICB added.
Meanwhile, Pulse has learnt that NHS leaders in Devon are also taking steps to ensure practices will not lose out financially from QOF as GPs prioritise urgent care.
In December, a bulletin from the ICB said GPs would get QOF income protection during ‘worst ever’ winter pressures.
It said it would income protect QOF for 2022/23 to enable practices to use their clinical judgement on how best to prioritise workload and workforce ‘without concerns around the potential financial impact’.
But Dr Bruce Hughes from the medical executive team at Devon LMC told Pulse the ICB had been advised that they cannot suspend QOF as it a national scheme.
‘However, they have agreed a package of support to practices in Devon to allow them to prioritise on the unprecedented demand without financial detriment,’ he said.
In Derbyshire, practices have also now been asked to suspend staff training or January with a critical incident still in force and the situation unlikely to improve.
An email to practice managers seen by Pulse said practices would be required to stand down Quality Education and Service Training (QUEST) ‘on the basis that the system is in a critical incident and next week is likely to be as busy or busier’.
On 23 December, a letter to healthcare staff in Essex acknowledged in some situations GPs ‘may need to depart from established procedures to care for people in these highly challenging but time-bound circumstances’.
But it stressed that staff would have the support of the medical director and chief nurse in making difficult decisions.
Peter Higgins, chief executive of Lancashire and Cumbria consortium of LMCs, said virtually the whole of general practice in the region was at ‘red’ alert.
‘Our ICB has said it is not allowed to suspend QOF or IIF but has applied discretion on local enhanced services.
‘There has been a small amount of temporary funding to give some respite over the Christmas period but this is all to be swallowed up by the respiratory hubs.
‘We would much rather see this money going directly into core general practice as this is the right place, with the right skills, expertise and relationships with patients for this work to be carried out.’
One LMC leader said it was clear that NHS England were putting pressure on ICBs to not give any leeway on QOF or other targets despite infectious diseases completely swamping already poorly resourced and stretched services.
In West Yorkshire, a letter from the ICB – first seen by ITV – asked GPs to ‘step down’ routine activity to prioritise urgent care because of extreme pressure on hospitals over the bank holiday period.
It added that GPs should ‘ensure all people are seen before sending to hospital where clinically appropriate’.
An updated letter this week from West Yorkshire ICB said practices would need to continue prioritising urgent appointments and the ICB was liaising with NHS England on what arrangements could be put in place to ensure practices ‘do not lose out if planned commitments are impacted’.
Dr Richard Vautrey, assistant secretary of Leeds LMC and clinical director Central North Leeds PCN, said: ‘Whilst practices are doing all they possibly can to manage this current massive level of demand for appointments and the workload pressures in general it’s only possible to step down routine and non-urgent activity for any length of time if NHSE suspends and income protects QOF and IIF.
‘This is something local LMCs have been calling for but so far NHSE nationally have been refusing to listen.
‘It’s vital that they do so as soon as possible as the current workload pressures are greater than at any time during the pandemic. There’s little else that local ICBs can do that they’ve not done already.’
An NHS England spokesperson said: ‘There are no plans to suspend QOF nationally. NHS England has already encouraged local areas to use flexibilities where they can to support practices and this was set out in a letter in September.’
Before Christmas, the BMA wrote a template letter to ICBs asking for QOF and IIF to be protected for the remainder of 2022/23.
At the time, it said the move came as NHS England ‘has indicated that at this time it will not be issuing a national pause on these areas of work, although ICBs are able to institute additional support for practices to help bolster them during such an unprecedentedly busy time’.
The BMA has also asked the CQC to suspend all routine and non-urgent CQC inspections.
And this week, it called for an urgent injection of funding from the Government to ease pressures, as Doctors Association UK revealed GPs are being forced to drive patients to hospitals amid ambulance delays.