Exclusive GP practices will have to submit ‘evidence-based’ claims to access £250m winter funding, such as payslips demonstrating staff have worked more than usual, NHS England has said.
In new guidance on the ‘winter access fund’ sent to systems this week and seen by Pulse, NHS England set out further details on the process for accessing the cash.
It said that eligible practices – which must fulfil the ‘gateway criteria’ of being identified by their ICS as ‘a practice in need of support’ from the fund and signed up to the pharmacy referral scheme – will have to submit claims supported by ‘robust’ evidence against set ‘criteria’.
The document said: ‘Practices or other service providers should submit evidence-based claims in line with ICS plans – no claims outside the agreed plans should be approved unless there has been agreement with NHS Regions to plan amendments.’
Evidence can include ‘payslips for the three months prior to the additional sessions being run – as evidence of the overtime baseline prior to the additional sessions’ to demonstrate that staff have worked ‘overtime’, it added.
Other examples of evidence are additions to current job descriptions or contracts of employment and payslips or other proof of payment for any new staff.
It said: ‘Claims should provide evidence that demonstrates how these interventions have supported improved patient access or experience – and that the interventions are additional to the services provided and paid for prior to the intervention and associated claim’.
ICSs and CCGs will review the claims using a ‘risk-based approach’ to sampling claims and ‘validating evidence supplied’, the document said.
‘Practices and other providers will only need to supply the evidence listed below if and when their CCG/ICS requests it’, it added.
NHS England will also monitor ‘progress’, with a process that ‘aims to appropriately balance the need for robust financial controls with the need to minimise the workload for ICSs and GP practices’, it said.
It will ‘review a randomised selection of practice plans each month, with more in-depth reviews triggered as appropriate’, it added.
Practices must submit claims ‘promptly’ and ‘no later than two weeks after the end of the month when the costs were incurred, with claims to be approved ‘within one month’, according to the supplementary guidance.
However, ICSs can begin spending ‘according to their November plan on a provisional basis’ – ahead of formal approval of their ‘fully-costed system plans’, it said.
It added that each ICS will be allocated a ‘notional budget’ and will be ‘expected to manage the claims from practices and elsewhere in their system within that funding envelope’.
But funding can be re-distributed ‘as appropriate/necessary’ both within and across regions to ‘maximise expenditure’, it said.
The guidance set out that costs eligible to be covered by the fund include:
- Funding more sessions from existing staff, locums or ‘other physicians’
- Expanding extended hours capacity, such as ‘any contingency planning for bank holiday working’
- Using administrative staff including at PCN, federation or practice level ‘where commissioners agree that is what is needed and the optimal model’
- Increasing the resilience of the NHS urgent care system during winter by expanding same-day urgent care capacity
- Using primary care hubs such as respiratory hubs or 111 Clinical Assessment Services (CAS) capacity ‘where general practice is unable to expand’
Rates for any additional locum capacity ‘should not exceed £200 a session’ or £250 for out-of-hours work such as bank holidays and any higher rates must be approved by regions, it said.
ICSs can also identify ‘other supporting actions that improve patient experience or access’ to be funded by the package, it added.
Meanwhile, the guidance also said that ICSs must express an interest in the separate £5m security fund by 30 November in order to secure funding for their practices.
However, regions will have to ‘prioritise against their allocation using a risk-based approach to requests for practice security upgrades’, it added.
Under the £250m access plan announced earlier this month, ICSs were asked to submit a plan for tackling GP access challenges in their area – including a list of the 20% of practices with the lowest levels of face-to-face appointments to face ‘immediate’ action – by 28 October.
The BMA’s GP Committee has voted to ballot the profession on potential industrial action and called on practices to disengage from the PCN DES in protest to the access plan.
The BMA has also advised practices to immediately start offering consultations of 15 minutes or more; and apply to close their patient list, as part of the fightback against the plan.