NHS England has confirmed plans for this year’s 10% increased elective activity target to be predominantly achieved through increased GP advice and guidance (A&G).
The plans were first revealed in draft guidance seen by Pulse last month, which set out that GP A&G ‘could contribute an estimated six percentage points’ towards the target of ‘over 10% more’ activity.
Final NHS England elective recovery planning guidance published yesterday enshrined the plans, including that the number of pathways ‘completed in primary care with the support of specialist advice’ without onward referral will be monitored through a new dataset – the Elective Recovery Outpatient Collection (EROC).
It said that further guidance on this monitoring approach is available on NHS England’s FutureNHS planning platform.
The guidance added that local commissioners will also be monitored against the target of a ‘minimum’ 25% reduction in the following up of outpatients by March next year.
They should plan how they will redeploy released capacity, including to ‘increase conducting A&G in co-ordination with primary care’, it said.
A&G involves GPs accessing specialist advice by telephone or IT platforms, rather than referring patients for a hospital investigation.
The guidance also added that local commissioners and providers should consider how ‘optimal referral management will happen’.
It said that plans must demonstrate ‘an ongoing commitment to the clinical validation and prioritisation programme, including the conduct of three-monthly reviews for patients waiting over 52 weeks and at least weekly reviews for those waiting longer than 62 days on a cancer pathway’.
However, it remains unclear who will be responsible for managing and validating waiting lists, with GPs previously told they could be asked to review hospital waiting lists for elective care.
And the guidance set out that local commissioners should ‘review of primary and secondary care operating principles’ to ensure patients are offered a choice of providers ‘at the point of referral into elective pathways’ via a ‘shared decision-making conversation’.
It added that primary care networks could be responsible for supporting patients who are waiting for elective care.
It said: ‘Systems should consider what additional support or services for patients on the elective pathway is available through local voluntary and community groups.
‘This may include work with primary care networks to recruit additional social prescribing link workers, care coordinators, and health and wellbeing coaches.’
ICSs must now develop plans outlining how elective targets will be achieved, including ‘going further for those that are able to’, NHS England said.
Chief executive of Lancashire and Cumbria consortium of LMCs Peter Higgins told Pulse that his ‘main worry’ is that A&G is ‘just another mechanism for pushing more work back to general practice’.
He said: ‘It can be a good thing if it’s planned well and it’s planned jointly between primary and secondary care, but the worry is [that] it’s just another mechanism – if it goes wrong or if it’s abused – for pushing more work back to general practice and that’s our main worry.’
He added that it’s ‘absolutely not’ fair that GPs effectively have been asked to mop up most of the hospital backlog and that there is no capacity to do so.
Mr Higgins said: ‘It assumes that capacity is there to do the work and it just is not.
‘It seems like the Government is full of good ideas, but not the wherewithal to implement them because there just aren’t the staff there, either in general practice, community services or indeed in hospital services.’
Former BMA GP Committee England chair and Leeds GP Dr Richard Vautrey added that while A&G ‘can often be helpful’, setting ‘arbitrary targets’ to increase its use could be ‘completely counterproductive’ if it becomes a ‘requirement’ and referrals are ‘restricted or prevented’.
Dr Vautrey, who is also Leeds LMC assistant secretary and Central North Leeds PCN clinical director, said: ‘Moreover, these plans make no provision for the necessary increase in the GP workforce or shift of resources required for more work to be done in general practice.
‘It’s not acceptable for GPs to be expected to help solve the massive backlog in NHS care without being given any of the funding required.’
In January, NHS England planning guidance set out ambitious targets for ‘over 10% more’ elective activity in 2022/23 than before the pandemic.
And the Government’s long-awaited elective recovery plan – published in February – stressed that GPs’ role in tackling the NHS hospital backlog will focus on the use of A&G to try to avoid ‘unnecessary’ referrals to secondary care.
It comes as Pulse revealed earlier this month that GPs could be held liable for advice given to them by hospital colleagues about their patients via A&G services.
And NHS England warned last month that the second wave of the Omicron strain of Covid is putting the delivery of the elective care recovery plan at risk.
PCNs are due to be incentivised for using A&G through ‘Investment and Impact Fund’ (IIF) points worth £9.9m in 2022/23, however GP leaders have raised concerns about its workload impact in general practice.
Elective recovery plan targets
- Eliminate waits of over one year by March 2025 and waits of over two years by July 2022, acknowledging that some patients will choose to wait longer and there will be ‘challenges’ in particular specialties as before the pandemic;
- Reduce diagnostic waiting times, with the aim of least 95% of patients receiving tests within 6 weeks by March 2025;
- Deliver the ‘cancer faster diagnosis standard’, with at least 75% of urgent cancer referrals receiving a diagnosis within 28 days by March 2024 and return the 62-day backlog to pre-pandemic levels by March 2023.
- Better ‘monitor and improve’ both waiting times and patients’ experience of waiting for first outpatient appointments over the next three years