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’.
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.