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Worst-performing GP practices will get no winter funding, NHS England advice confirms

Worst-performing GP practices will get no winter funding, NHS England advice confirms

NHS England has confirmed that some practices needing access ‘support’ will not be eligible for the GP winter access funding.

It also suggested that it will not set a specific target for levels of face-to-face appointments in practices.

New guidance on the ‘winter access fund’ sent to systems this week, seen by Pulse, said that ‘some practices in receipt of enhanced support will not be eligible for funding’.

Such practices could include those that are not meeting pre-pandemic appointment levels ‘without CCG/ICS-validated reason for lower levels’, whose levels of face-to-face appointments are locally assessed to be a ‘clinical concern’ but are ‘not taking action to remedy’ this or who are not signed up to the pharmacy referral scheme, it said.

NHS England also said it has not ‘set a specific target level for the proportion of face-to-face care’ and that ‘the right answer will depend on the population being served and the operating model of the practice’. 

‘Digital tools and telephone appointments continue to be an important part of care delivery for the future’, it added. 

NHS England chief executive Amanda Pritchard told MPs that NHS England has not defined the ‘right number’ of GP face-to-face consultations, as this is likely to vary depending on patient populations.

Speaking at a House of Commons health committee evidence session last week, she said the NHS has ‘really tried to steer away from saying that there is a kind of a right number for face to face versus other types of access.’

She added: ‘What’s clear is many people absolutely do prefer face-to-face access. ‘GPs are required to provide it, it’s part of the contract. But for some populations, it’s going to be a particular number and for others it will be different.’

NHS England has tasked the RCGP with providing guidance on the ‘optimal blend’ of remote and face-to-face care by the end of November.

The supplementary guidance suggested that NHS England will not publish the list of the 20% of worst-performing practices identified by each ICS to receive access support.

It stressed that the original access plan ‘does not include any intention to publish lists of practices requiring enhanced support’. 

It added: ‘Accordingly, templates should be submitted to NHSEI using anonymised codes to identify practices rather than their names.’

The BMA has hailed this as a victory and ‘concession’ for GPs, according to media reports.

However, the original plan did set out that NHS Digital would begin publishing practice-level GP appointment data and waiting times by spring next year, including the ‘proportions of appointment by different professions’ and whether appointments are face-to-face or remote.

NHS England and the BMA did not respond to requests for clarification and it remains unclear whether this publication will still go ahead.

The new guidance added that a ‘combination of data sources’ will be needed to identify this list, as NHS Digital appointment data is ‘experimental’ and has ‘issues’.

It said: ‘A combination of data sources will need to be triangulated to identify practices and populations in greatest need. 

‘National appointment data have been shared as a guide given that this reflects appointment activity reported from practice appointment books and published at CCG level by NHS Digital. However, this is experimental data and data issues are highlighted in NHS Digital’s publication. It should be used carefully and supplemented.’

However, it did not set out what other data ICSs should use.

Meanwhile, the new guidance also said that ICS would identify a ‘maximum of 20% of practices’ for ‘enhanced’ access support.

It added: ‘This proportion could be smaller if that is the appropriate focus for the system. There are likely to be a variety of different causes, which the ICSs will want to understand as they agree subsequent actions.’

Elsewhere it reiterated that the list is ‘unlikely to be more than 20% of all local practices’, but NHS England also did not clarify this to Pulse.

The guidance set out that individual practice action plans could include:

  • ‘Intensive support’ from the ‘access improvement programme’
  • ‘Implementation support’ for example relating to the pharmacy referral service
  • ‘Partnering support’ with other local practices
  • ‘Support linked to the winter capacity fund’

It reiterated that it ‘may be appropriate to deploy contractual mechanisms or involve the CQC’ in some instances but said this would ‘most likely’ be ‘in a minority of cases’.

The guidance also set out how practices can access the £250m winter funding, saying they will have to submit ‘evidence-based’ claims such as payslips demonstrating staff have worked more than usual.



Please note, only GPs are permitted to add comments to articles

David Church 29 October, 2021 5:25 pm

I’m really not sure I can understand how the most needy Practices should be denied any help, while others get extra funds – unless the plan is to destroy the weakest 20% in some sort of bizarre ‘natural selection of the fittest’ process.
Don’t forget, once that 20% are gone, those who are ‘average’ now, will be only a few points above the bottom 20% next time around………

Simon Ruffle 29 October, 2021 5:33 pm

As the former education secretary stated I want all schools to be above average, reality is beyond these people and Sisyphus had an easier time of it than GPs

Robert James Andrew Mackenzie Koefman 29 October, 2021 5:35 pm

Absolutely counter productive what a mess lets hope our leaders dont accept

Turn out The Lights 29 October, 2021 6:29 pm

I suspect our leaders will love it and carry on aiding the destruction of GP land by this bunch of Muppets.Even if offered it I wouldn’t accept it it doesn’t address the issues.We are drawing and the are throwing a concrete life ring to drowning people again.Pathetic.

Patrufini Duffy 29 October, 2021 7:50 pm

The money is dirty money. From corrupt hands and the employer that wants you gone. Don’t take it. It’s smells off.

Patrufini Duffy 29 October, 2021 7:54 pm

20% is probably what most politicians and NHSE blue suiters and party dressers got in biology, maths and common sense. The upper limit of statistical relevance to them. Surprised they didn’t make it the bottom 100% based on their myopic logic. They’re following the same brain modelling and thinking that has decimated 160,000 people on their watch, and counting. Well played. Just blame a GP its easier scapegoating, and smokescreen for your corruptions.

Iain Chalmers 29 October, 2021 9:34 pm

Which bit of “levelling up” concept isn’t included??

Simon Sherwood 30 October, 2021 7:03 pm

2 years ago our idiot health secretary was championing companies that skimmed off the easiest patients to be dealt with remotely saying this was the way forward.

Just My Opinion 2 November, 2021 9:12 am

Nowhere in the GMS contract does it say we have to provide face to face access.

Sanjeev Juneja 4 November, 2021 10:46 am

I think, first, we need to analyze why these Practices are underperforming.There is a strong possibility that they do not have a CCG or LMC representative or they have been underfunded for a long time – That is the dismissive explanation given by CCGs, LMCs and NHSE when approached by underfunded Practices. The just blame it on ‘ historical underfunding’ and don’t ever attempt to rectify things. Only when this aspect has been looked at, a further scrutiny and Practice needs need assessment. Punitive measures will only result in loss of morale and precious manpower.