GP recovery plan update highlights 111 referral crackdown

NHS England has set out what progress is expected on the GP recovery plan during 2024/25, including ensuring practices only divert patients to 111 in ‘exceptional circumstances’.

Other key targets included reducing GP workload by further reducing bureaucracy; improving interface with hospitals; and increasing the number of patients who self-refer to specialist treatment.

The GP recovery plan, published in May last year, focused on a move to ‘modern’ general practice and tech updates funded by £240m.

In an update letter to ICBs, published today, NHS England suggested that PCNs should be holding practices to account on core-hour 111 referrals, using newly shared data on the number of calls patients make.

‘We will begin to share data on the number of calls to 111 in core hours with primary care networks (PCN) clinical directors, to support quality improvement, so practices only divert to 111 in exceptional circumstances,’ the letter said.

NHSE clarified to Pulse that this data will show the number of patient calls to 111, rather than the number of calls from GP practices. Although GP leaders suggested this was not within practices’ control.

Last year’s recovery plan had said GP practices should only direct patients to NHS 111 in ‘exceptional circumstances’, and must inform their ICB when doing so. 

Other progress expected from ICBs during 2024/25 included:

• ‘further increase’ self-referrals by ‘at least’ 15,000 patients a month in pathways where ‘general practice involvement may not be necessary’
• roll out ‘easy-to-use online registration’ service to 90% of practices by 31 December 2024
• grow monthly patient volumes at pharmacy services by:
  • At least 71,000 blood pressure check consultations;
  • 25,800 oral contraception consultations;
  • 320,000 Pharmacy First clinical pathways consultations
• Resolve ‘any outstanding issues’ for the practices who do not yet offer prospective record access
• PCNs should review how digital telephony is being used across practices (including number of calls, average wait, abandonment time, average call length) to support ‘quality improvement’ in how demand is managed
• Increase the use of ‘higher quality’ digital tools
• Practices should implement a ‘single view’ of all patient requests, whether online, phone or walk-in.

On the primary/secondary care interface, NHSE said: ‘Our goal for 2024/25 is to provide more support to ICB [chief medical officers] with national leadership co-led by the NHS England national medical directors for primary and secondary care.

‘We have already asked ICBs to report progress through their public board in April or May and will again ask ICBs to do this in October or November 2024. This will be a focus for 2024/25 and we are looking for significant progress on implementation, recognising the benefits for patients and staff alike.’

Last year, ICBs were required to report progress on cutting bureaucracy for GPs by improving the interface, specifically on onward referrals, fit notes, and discharge letters.

But many ICBs reported issues with progressing this work, with some saying hospitals have not prioritised the improvement work.

At the end of last month, NHS England announced that ICBs must ensure each hospital trust has a ‘designated lead’ for improving the interface, in its 2024/25 planning guidance. 

In order to ‘build capacity’ in general practice, NHS England has also recognised the need for more GPs and has pledged to grow GP specialty training by 500 places in 2025/26.

This is in line with the NHS long-term workforce plan ambition to increase GP training places by 50% to 6,000 by 2031.

NHSE outlined progress so far on the recovery plan, confirming systems had so far:

• expanded the pharmacy oral contraception and blood pressure services in December 2023
• launched Pharmacy First in January 2024
• delivered transformation support to more than 1,650 practices via the National General Practice Improvement Programme
• exceeded goal to deliver 26,000 more direct patient care staff, having delivered over 36,000 more since 2019.

And partly completed:

• enabling full prospective record access – 84.1% of practices have enabled patients to view prospective records (the target was for 90% by March 2024)
• implementing digital telephony, with over 90% of practices having completed this and the remaining 10% due to complete the process by May 2024
• changing local authority planning guidance to ‘raise the priority’ of GP estates – NHS England said work is ‘underway’ with the relevant Government department.

Dr Amanda Doyle, NHSE’s national director for primary care, said ‘important progress’ had been made over the last year, including on self-referral and blood pressure checks, which do not require GP involvement.

‘And we want to make sure that this offer is available to even more people which is why we are expanding the offers in our primary access recovery plan including increasing the number of people who can self-refer for common services without a GP referral – not only is this good news for patients but it will also free up family doctors who are already delivering millions more appointments a month than before the pandemic,’ she added.

On the plans to share 111 call data with PCNs, Association of Greater Manchester LMCs chair Dr Amir Hannan told Pulse that he does not think this is within the control of GP practices, and that this ‘opens up a can of worms’.

‘There’s many, many, many factors that go into it, depending on the population, the health inequalities that exist there, the ageing population. You have the people that are more likely to dial 111 and older people are less likely to. There’s so many other factors that go into it,’ he said.

Dr Hannan said there are ‘too many confounding factors’ to hold practices to account on the number of 111 calls.

‘I just wish that they’d invest some of the money into general practice to enable us to be able to deal with more of our own patients, instead of these other things that add very little value,’ he added.