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Practices can ‘no longer ask patients to contact them at later date’ under contract changes

Practices can ‘no longer ask patients to contact them at later date’ under contract changes

GP practices must offer patients an assessment or signpost them to an appropriate service on first contact, in newly-announced changes to the GP contract for 2023/24. 

It is not clear what is meant by ‘appropriate services’, but NHS England did say that practices can ‘no longer ask patients to contact them at a later date, and is part of NHS England’s focus on ensuring consistency in the access patients can expect’. 

The contract also makes changes to the investment and impact fund (IIF), which will now focus on access, including reducing the number of indicators from 36 to five.

These indicators, worth £59m, will focus on a small number of national priorities, including flu vaccinations, learning disability health checks, early cancer diagnosis, and two-week access. 

The remaining £246m of the IIF will now be ‘entirely focused on improving patient experience of contacting their practice and receiving a response with an assessment and/or be seen within the appropriate period’.

Most of this fund (£172.2m) will be provided to PCNs in a monthly payment during 2023/24, in a similar way to QOF aspirational payments. 

The remaining 30% (£73.8m) will be awarded to PCNs by ICBs at the end of March 2024, based on an assessment of ‘demonstrable and evidenced improvements in access for patients’.

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The emphasis on access in the IIF changes is the latest in the long-running push by NHS England and ministers to place the burden of increasing access on GPs. 

Last month, the BMA GPC rejected the ‘insulting’ contract offer from NHS England, warning that it would risk patient safety and cause more GPs to leave.

At the end of last week the GPC was ‘dismayed’ with the health secretary’s refusal to offer more than this, according to acting chair Dr Kieran Sharrock. 

The GPC has said it will be exploring all options following the imposition of this contract, including potential industrial action. 

Under the new IIF arrangements, the Learning Disability Health Checks Indicator will have a new requirement to record the ethnicity of people with learning disabilities. 

Another change is a new Personal Care Adjustment (PCA) which will be added to the indicator on FIT testing, to avoid PCNs being incentivised to refer for FIT testing when there is rectal bleeding.

To help practices who are struggling to access tests, NHS England will set up a national ‘supply chain’ escalation system for GPs to contact if they are experiencing supply issues locally. 

The changes to the contract for 2023/24, which is the final year of the five-year framework agreement, will be supplemented by guidance in a new Delivery Plan for Recovering Access to Primary Care which NHS England said it will publish shortly.



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

Simon Gilbert 6 March, 2023 5:00 pm

A/E ‘Must’ see patients within 4 hours.
Hospital outpatients ‘Must’ do internal referrals for the same problem and not ask Gp to make the referral.
IAPT ‘Must’ have a process to refer and discuss with CMHT according to their contract.

‘Must’ is overrated.

Not on your nelly 6 March, 2023 5:03 pm

I suspect 111 are about to get very busy.

Mr Marvellous 6 March, 2023 5:03 pm

We’ll be signposting all patients to 111 or ED.

Sorry/not sorry.

Just My Opinion 6 March, 2023 6:54 pm

ED much safer than 111, which is a national embarrassment.
So for me, all to ED.

Adam Crowther 6 March, 2023 8:21 pm

When do you want your appointment? Tomorrow at 11.30. Sorry that one has gone! Any other times in the next 2 weeks? Sorry I have not got my diary. Afraid I can’t ask you to call back so you will have to go to ED. This is just more total bonkers from NHSE. I can’t believe they pay people (am sure more than one) to come up with this guff! 😩

Anonymous 6 March, 2023 10:16 pm

If you ring at 0805 am and all appointments have been taken, no wonder they are trying to change this.

If you offer brief triage on the same day that’s all they need. Following triage they can wait for their appointment or should be redirected elsewhere.

You will only have a problem, if you haven’t adapted to modern way of working with total triage.

Mark Funnell 6 March, 2023 11:07 pm

So basically we are being to dumb down what we currently offer, take up a significant chunk of the capacity we have to treat patients in triaging everyone who wants a contact regardless of how many call on the day. We have always known about the “iceberg of unmet need” in our primary care practice & that you can open up as much capacity as you like and we will not meet need, just encourage lower level issues to come forward.
Pharmacists are not available to dispense in my area let alone deal with minor illness.
No NHS dentistry either around here
There is the potential to spend most of my day triaging & nowhere to do any work. And what is going to happen to the face to face figures whilst we do all this, presumably telephone-based, triage?
We already deal with 40-50 patient contacts a day each (more in some areas I am sure) & we cannot just keep constantly increasing that number without burnout & clinical errors.
No “spare” staff to add to the mix in my area either so cannot expand the team or even fully utilize the ARRS funding – PCNs & local practices fight over the limited resources we have.
So once again politicians seeking their vote at the next election enforce contract changes that mean that, if we follow the process, they can say that everyone is getting access to a GP/primary care service quickly – we may not treat the patient or make them better but they do have access! And that will be the definition of having delivered on their pledge to the electorate?!
I believe the British people are well able to see through this ruse but sadly the question is whether they will have a service to use by the time the next election comes around.

Slobber Dog 7 March, 2023 8:04 am

Not a problem if we have sufficient clinical staff and consultation space .

David Mummery 7 March, 2023 8:10 am

Has NHS England ever heard of self-limiting illness? We see quite a lot of it in Primary Care

Michael Green 7 March, 2023 11:22 am

When reach capacity just set the answerphone to record “What is the reason for your appointment….” and after 30 seconds, advise to call 111. Done.

Matthew Jones 7 March, 2023 7:24 pm

Anonymous: Total triage.

I completely disagree. I think it leads to dissatisfied GPs and dissatisfied patients.

20 patients face-to-face is bad per session. But 20 telephone triage telephone triage calls is just awful.

Total triage HAS to promote ultra quick consults – because otherwise how is it quicker than 10 mins face-to-face.

Why are we so quick to abandon non verbal communication and clinical examination.

It will lead to mistakes being made. And only one person will be to blame. Not NHS England. But the GP making the call.

Just about the worst possible move for the direction of GP. It will make the job – just horrendous.

Thomas Cochrane 7 March, 2023 8:30 pm

Anonymous…While I see where you are coming from unfortunately your argument has one basic simple flaw….. things are at the point where even “brief triage to all”., where “all” is a magic undetermined number which could be any factor of whatever number you choose is just fantasy land!!!! …… ” Brief triage to all” in itself will see the GP ship sink!!

Just Your Average Joe 11 March, 2023 7:15 pm

Say no to unlimited demand for appointments which includes self limiting illness and multiple contacts for the same problem ieven having seen AE/OOH /111 day before.

We are paid for 3 contacts a year and the average is closer to 2 to 3 times this level.

Give us the funding and staff to match this DOH generated increase in demand then we might be expected to supply that.

No funding, not enough staff and heightened expectations again being ramped up.

Time for BMA to develop a spine and a united work to safe levels the triage all extra to 111/AE for a few days and watch the DOH opposition to supporting primary care vanish or continue till election time and dare Labour to not promise to fix it as part of election promises

Faen Faen 19 March, 2023 10:14 pm

Signpost to call back later.