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.’
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.