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20% of GP practices with lowest F2F appointment levels to face ‘immediate’ action

20% of GP practices with lowest F2F appointment levels to face ‘immediate’ action

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’.



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

Patrufini Duffy 14 October, 2021 12:07 pm

Let us get the facts right.
That this Government has got away with killing off more than 161,798 people, and 972 in the last week. People, yes, humans. These were patients. They killed 161, 798 patients – without a ring fence or ownership. You went in to help, they’ve pocketed the money, got away with murder, and taken the lives of your colleagues and ethnic minorities on the front line. They’re the ones hiding, and taking accolades for your incomparable work. And now they’re tracking you? And shaming you publicly. Disgusting moment in history.

Reply moderated
Richard Greenway 14 October, 2021 12:27 pm

When we signed up to share our appointment details with NHSE we were told this would not be used to performance manage us. Hasn’t taken long before its another stick to beat us with. No wonder trust is so low.

Reply moderated
Simon Ruffle 14 October, 2021 12:30 pm

Remember when the education secretary said he wanted all schools above average! Set standards by all means but rankings will always leave someone bottom even if they are performing well.

Vinci Ho 14 October, 2021 12:57 pm

You see
You have to understand this is part of the grand plan to put the last nail in the coffin , or last straw on camel’s back as I wrote under the other article today .
If you are part of the political engine : propaganda media-Ministry of Plenty-Secretary of State-the ruling party , you would be wrong not to include this ‘measurements’ for 20% alongside with the rescue package announced today .
And also , as I wrote today , the government is both incompetent and duplicitous . The rescue package will be politically meaningless without punitive measures . For those who understand politics well always remember this rule of thumb.

Reply moderated
Mark Howson 14 October, 2021 1:11 pm

The GMS contract is clear it is the clinician who decide when where and how a consult happens. They can only do this by changing the contract.

The alternative I think is see everyone F2F and tell patients that is why they are waiting two months for an appt. just to discuss their normal blood results. But hey at least it is better than the wait to see a hospital doctor.

You can have F2F for everyone and long waits or total triage and often seen same day if necessary.
You cannot rationally have both.

If we go full F2F it will be a lot stressful as long as people accept they will be on a waiting list and will be seen when it is their turn.

Cameron Wilson 14 October, 2021 1:45 pm

Nothing we do will ever be enough! No point in even trying, it’s patently us v HMG and their lackeys! They really need us far more than we need their toxic relationship. Time to move on!

Reply moderated
Guy Wilkinson 14 October, 2021 1:47 pm

Let the CCG/shadow ICS try this.

Do they really want to start a contractual fight with 20% of practices?
BMA GPC need to jump all over this and take aggressive contractual legal action.

Guy Wilkinson 14 October, 2021 2:03 pm

You can only assume that they will shutdown Babylon??

Err wait…exceptions will be made for cherry pickers….

Patrufini Duffy 14 October, 2021 3:32 pm

Nikki Kanani states “I’m taking some time off Twitter because it is toxic and demoralising no matter how hard you work”.

Let me read that again…

Martin Tant 14 October, 2021 3:46 pm

Oo! Oo! Pick me, pick me!

Simon James Cawood Butler 14 October, 2021 4:20 pm

Just when I’m thinking about giving up general practice because it’s got too frantic…….

PAUL BALLINGER 14 October, 2021 6:07 pm

The government is absolutely right. I see at least 80 pc face to face and there’s no reason why that can’t apply to every doctor. Well done Saj

Reply moderated
john mackay 14 October, 2021 9:30 pm

@paulballinger there are lots of reasons why the number of patients you see F2F shouldn’t apply to every doctor. Unbelievable arrogance, “it’s right because I do it”
Wow. Perhaps you should reflect on this in your next appraisal.
F2F presumably.

Anonymous 14 October, 2021 10:03 pm

Dead cat strategy

PAUL BALLINGER 15 October, 2021 7:29 am

The government has in fact achieved an excellent package which reflects the concerns of the public and deserves our wholehearted support. Well done Saj!

john mackay 15 October, 2021 2:33 pm

@paulballinger. You should read the NHS survey rather than the Daily Wail to find out what patients want. In the 2021 survey, 94% of patients said that their needs were met during their last GP appointment, and 96% had confidence and trust in that healthcare professional. Meanwhile in an askMyGP survey of over 140,000 patients who contacted their practice recently via the phone or online, only 13% wanted a F2F response.

Never let actual data get in the way of a great campaign though eh?

Perhaps you should add that to the growing topics you need to reflect on in your next appraisal?

David Church 15 October, 2021 5:11 pm

Quite right too.
Any practice in that lowest 20% should be immediately sent 3 retired geriatricians WHO CAN USE THE GP IT systems !

Shaba Nabi 15 October, 2021 8:02 pm

Kevlar Cardie

You made me laugh out loud in the kids swimming pool area!

nasir hannan 17 October, 2021 8:29 am

We are planning for a return to face to face however this will necessitate an end to telephone consultation as we will be unable to resource both. We will keep a digital platform ongoing however this will could lead to a reduction in capacity issues. We have been able to expand our offering as a result of telephone triage however I do think that the telephone triage model has been viciously attacked and is now a toxic medium. This is incompatible with the safe delivery of care and has affected the doctor patient relationship. Interestingly they are asking for an increase in f2f assessment but at the same time have still requested a maintainance of the 1m rule in the waiting room. I feel that this was the wrong time to ask. I am not sure what the evidence base is behind the reduction for 2m to 1m in gp surgeries are. Either it is 2m or none at all. We have limited waiting room space and increased f2f would necessitate more waiting room space.

Dave Haddock 17 October, 2021 9:37 pm

Amazed at how few f2f consultations some Practices get away with, I don’t want to be registered there.

But this is between doctors and their patients; trying to dictate acceptable numbers if f2f consults is a classic example of the centralised command and control bullying that has done so much to make GP a recruitment desert.

And the idea that the RCGP can give any useful advice, truly frightening, they have no insight, no self-awareness at all.

Simon Sherwood 17 October, 2021 10:56 pm

Dear saj.
The workforce is walking away.
I for one won’t ever be back.

It may have been your plan, I can’t imagine you really thought continually beating people in a shortage profession that requires long training would be at all helpful.

Over to you now. You and your government have made practising good medicine in a deprived area impossible.

Patrufini Duffy 18 October, 2021 3:23 pm

Just close 20% of surgeries down.
Then the next year another 20%.
Then another 20%.
Then we’ll see what kind of joke this really is. Do it.

Paul Cundy 18 October, 2021 11:15 pm

Dear All,
So that will include the practice the mad Hatter is registered with, Babylon?
Paul C

Bawbag Ballinger 19 October, 2021 7:39 pm

When I were an ‘Ouseman I’d gerrup 3 ‘ours before I want t’bed in t’ on-call room then
t’Reg’d bleep me to beat me senseless wi’ sully end of t’ Thomas splint …and send me off t’clerk sixty patients in before t’sun rose.

and I were GRATEFUL.

I’d work 180 hours week wi’ out sleep, pay, food or …or…AIR.

It were wunderful !

‘Uman rights for t’docs ?

Looxury !!!

Subhash Chandra Bhatt 15 November, 2021 6:08 pm

Questions to ask should be?
Were you refused face to face consultation?
Why did you ring 111 ?
Why did you gibto a and e?
Then analysis access.