Commissioners have been told to immediately begin identifying the 20% of practices in their area that are performing worst in terms of delivering face-to-face appointments, NHS England has said.
Practices identified as part of the exercise by integrated care systems (ICSs) may be forced to partner with other practices or face contractual action from commissioners, it added.
The measures come as part of a £250m ‘package of support’ for general practice announced today, which aims to ‘increase the proportion of appointments delivered face to face’.
Setting out the details today, NHS England said that all ICSs must start an ‘immediate exercise’ to identify any practices with overall appointment numbers lower than the ‘equivalent pre-pandemic months’ – excluding Covid vaccinations.
Its ‘plan for improving access for patients and supporting general practice’, published today, said ICSs must also identify the 20% of practices with:
- The ‘lowest level of face-to-face GP appointments – as opposed to whole practice, including appointments with other staff’;
- The ‘most significant level of 111 calls from their patients during GP hours’;
- The ‘most significant rate of A&E attendances compared to what would be expected’.
Each ICS must submit the list for ‘immediate’ action – which is ‘unlikely to be more than 20% of all local practices’ – to NHS England by Thursday 28 October.
The plan said: ‘A wide variety of actions are likely to be required to resolve the issues: for example, to increase resilience, smaller practices offering unacceptable access may be expected to partner with other practices, federations or PCNs, as an alternative to the application of contract sanctions and enforcement.
‘Where practices do not engage with support and are in breach of their contractual obligation to meet the reasonable needs of their registered patients, appropriate contractual action will need to be undertaken by CCGs/ICS.’
It added that the CQC will provide NHS England with practice-level data on complaints it has received and that they will work together to ‘make the required improvements across those practices which are not meeting people’s reasonable needs’.
The CQC is ‘rapidly developing’ an inspection methodology focussing on ‘access to GP services’ and will make unannounced inspections ‘where appropriate’, it said.
It added that the 200 GP practices with the worst access will face a more ‘intensive and accelerated’ action plan using the ‘interventions that have shown most impact’ and ‘on-site support’ to develop a tailored ‘practice improvement plan’.
The plan said: ‘Starting this month, a new intensive form of the programme will support more than a further 200 practices experiencing the greatest access challenges to help them reduce waits, increase the number of appointments offered each day, including through face-to-face care.
‘On-site support will be provided by primary care improvement experts. They will help practices assess demand and capacity, identify gaps with the service level and responsiveness sought by patients.’
Meanwhile, NHS England said that the £250m winter funding is dependent on ICSs tackling ‘variation’ in access to GP care.
National funding ‘will not be released to any ICS unless its plan adequately tackles’ increasing access for patients in the practices that are ‘struggling the most’, it said.
And practices whose GPs are not seeing enough patients face to face may be removed from the Covid vaccination programme, with their share of jabs ‘most likely’ given to community pharmacy, the plan added.
As part of the measures to improve access, NHS England said it will also commission a new QOF improvement model ‘focused on optimal models of access including triage and appointment type’.
All GP practices must complete a review of whether they have ‘got the balance right for patients between’ remote and in-person consultations as part of their ‘ongoing reflection’ by the end of October, the plan added.
NHS England said it comes as a ‘minority’ of practices are offering ‘wholly inappropriate access, with very low levels of face-to-face care’.
It said: ‘In August 2021, over 15% of practices recorded less than 20% of their GP appointments being held face to face. That is likely to be contrary to good clinical practice, even if it were to reflect the preferences of their patients.’
The RCGP will provide guidance on the ‘optimal blend’ of remote and face-to-face care by the end of November, it added.
This will include ‘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’.
The BMA has warned that NHS England’s package is ‘flawed and patient care will suffer as a result’.