Over 100 GP practices ‘performance managed’ by NHS England to improve access

Exclusive More than 100 GP practices in the South East of England were ‘performance managed’ by NHS England to improve access and reduce variation, as part of a programme laying the ‘foundations for neighbourhood working’.

The commissioner has released a final evaluation of Project 100 (P100), a ‘quality improvement initiative’ designed to tackle the ‘adverse variation’ in general practice performance across the South East.

NHS England said that the programme was developed in response to the 10-year plan priorities, including ‘improving access, reducing variation, and increasing capacity’ to provide ‘the right foundations for neighbourhood working’.

The project targeted 104 GP practices in the region, identified through national and regional performance data as having ‘the highest levels of adverse variation at that point in time’.

It comes after GP leaders told Pulse they were concerned that data provided by practices as per the GP contract could be used to identify practices who are underperforming or even ‘quoted against GPs’.

When the requirement to provide cloud-based telephony data was introduced, the BMA’s GP committee raised concerns that NHS England could use it to performance manage practices.

NHS England then claimed that the data was not going to be used to performance manage practices, but only to ‘better understand overall demand on general practice in advance of winter’.

The evaluation document, seen by Pulse, said that NHSE ‘implemented performance management’ via a monthly dashboard and structured working groups to ‘maintain grip, resolve barriers and spread learning’.

The evaluation found that the project ‘was not well received by all practices’, particularly those where data was ‘outdated’.

It also found that initially some practices ‘felt judged by Project 100’ and this ‘damaged relationships between the ICB and practices’.

However, NHS England said that the data indicates that Project 100 achieved its primary objective of ‘reducing unwarranted variation in general practice’ across the participating cohort.

‘Key areas of improvement’ included: 

• Monthly GP appointments per 1,000 registered population
• Monthly online consultations per 1,000 registered population
• GP registered population per GP full-time equivalent
• GP registered population per nurse full-time equivalent
• Patients on QOF LD register who received an LD health check

The evaluation recommended that P100 should be used as a ‘neighbourhood readiness test’, because it showed that ‘stable’ practices and ‘capable’ ICBs are ‘prerequisites for neighbourhood models’.

‘Improvement readiness should be established before large scale neighbourhood implementation,’ the evaluation added.

It also said that its findings around access indicate that improvement is ‘most effectively driven through supported operational redesign’, rather than ‘through performance management or capacity expansion alone’.

‘National operating models that emphasise headline access metrics without equivalent focus on front-door design risk driving superficial compliance rather than sustainable change,’ it said.

The document said that the programme ‘strengthened general practice as the foundation of neighbourhood delivery’.

It added: ‘During the project period (August – December 2025), there was a continuous decrease in the total number of adverse indicators and a corresponding increase in the total number of positive indicators.

‘There was also a continuous increase in the number of practices moving beyond the original thresholds for P100 (-6 adverse indicators & 0 positive indicators).

‘By stabilising access and outcomes, clarifying accountability between region and ICB, and building improvement capability within practices, it created the conditions required for neighbourhood working to function in practice.

‘Rather than laying new structures on fragile services, the model reinforces general practice as the stable platform from which place-based integration can scale safely and sustainably.’

On difficulties related to the data, it said: ‘The national GP dashboard received regular updates, including new metrics and changes to thresholds and weightings. This made practice conversations more difficult, as the “goal posts” would move month-to-month in the early stages.’

Case studies included in the evaluation said that some practices used the programme to address ‘performance variation, workforce pressure and poor patient experience’ following inadequate CQC ratings.

It said: ‘Through targeted ICB engagement, co-designed improvement planning and the rapid introduction of digital access solutions, the practice transformed access, quality and operational resilience.

‘Key changes included digital triage, extended online consultation hours, strengthened leadership and community engagement, and renewed in-house extended access provision.’

MPs have recently warned that NHS England’s ‘hyper-focus’ on access had knock on consequences for GPs ability to offer preventive care for older people.

And the new health secretary said that the Government will continue to keep its focus on GP access policies.